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Grief and loss experienced by frontline staff in long-term care may explain high staff turnover

Updated: Oct 22, 2023

Is it possible that unrecognized grief and loss amongst long-term care staff leads to high staff turnover? It is worthwhile to consider that the emotional impact of witnessing death, grief and loss on a frequent basis could be causing high staff turnover, costly sick time and low morale.

The emotional demand on frontline workers in long-term care is formidable. Long-term care staff witness death and dying on a constant basis, yet very little exists in the way of formal structures to support staff in their grief and loss.

In addition to witnessing an unusually high rate of death and dying, front-line staff in long-term care provide support, amidst their own grief, to residents and family caregivers managing the emotional impact of a loved one’s admission to facility and anticipated death.

Witnessing an adult lose independence and autonomy can be difficult emotionally, and often, even more difficult to witness the emotions of family caregivers during this process of transition, adjustment and loss. Adding to the emotional toll is the loss of often close, familial type relationships that staff develop with residents and family caregivers.

Staff may not recognize their emotions as related to grief, especially when grief and loss is not discussed during staff orientation and training. Most long-term care providers offer employee assistance programs that can help staff through emotional challenges, however, staff must be able to recognize their own grief before they can reach out for assistance.

Unaddressed grief can manifest weeks, months or even years after witnessing loss and individuals may not connect what they are experiencing with past grief and loss. A staff person’s attendance and job performance may be suffering but the reason may not be clear.

Unresolved grief can manifest physically and mentally. Chronic fatigue, attention deficit, forgetfulness, lowered immunity, depression, anxiety, insomnia, interpersonal struggles and dysregulation of emotions are examples of how unacknowledged grief and loss can show up and contribute to increased sick time and high staff turnover. In some cases, unresolved grief can lead to complicated grief, a heightened state of mourning which can include rumination of the loss, an inability to experience normal grief reactions and in severe cases, post-traumatic stress disorder.

The emotional numbness that often accompanies complicated grief leads to care that is task focused rather than person centered and a decreased capacity to respond to co-workers, residents and family caregivers with empathy. Ignoring the emotional impact of attending to others grief and loss on a continual basis can lead to compassion fatigue and burnout, resulting in staff resignations and extended leaves.

The good news is that long-term care organizations can help staff develop capacity and resilience for emotions related to their role in long-term care. In order to be truly effective in addressing staff retention and staff wellness, employers are tasked with educating and supporting staff to recognize and address grief and loss.

Peer mentorship programs build emotional resilience within teams by fostering positive and supportive relationships amongst staff, improving staff retention. According to a 2012 report by Quality Palliative Care in Long Term Care Alliance, staff report that the most beneficial form of grief and loss support often comes from peers. Having an opportunity to reminisce about a deceased resident provides staff an opportunity for closure and fosters staff wellness. A peer mentor can act as a facilitator for such discussions. Training peer mentors in grief and loss not only supports staff but peer mentors too as they find meaning and purpose in helping others, an effective antidote to grief.

While no two people experience grief the same, there are strategies that can help assure the wellness of all professionals who bear witness to others grief and loss on a regular basis. Strategies that help staff stay well despite the emotional demand of their role in long-term care begin with acknowledging the prevalence of death and loss embedded in the work; normalizing grief; validating emotions; creating opportunities for staff to express grief; developing peer mentorship and providing opportunities to debrief. These strategies promote awareness and build emotional resilience with the potential to reduce staff turnover and sick time, while improving the organizations culture and bottom line.

Providing a culture where staff can develop their capacity for understanding and managing emotions related to their work can help them discover renewed purpose and meaning in their role that they may not have considered in the past.

In addition to strategy and program development, staff debriefings following a resident death or difficult admission can provide further opportunity to build emotional resilience. Debriefing events offer validation and normalization of the complex emotions experienced by staff when someone they care for dies. The purpose of debriefing is to bring staff together to share their experience of a death or anticipated death and to openly discuss their reactions in a safe environment that offers mutual support.

It is important that debriefings are led by someone trained in facilitating debriefings. Facilitated debriefs require training and practice to master but with strong leadership, training and support, peer mentors can facilitate effective debriefing sessions in long-term care. To be clear, debriefings are not the same as therapy but they do have therapeutic value.

In summary, to create engaged, cohesive teams and improve staff retention in long-term care, consider the following:

• During onboarding and orientation, discuss the emotional demands of the job, including the high prevalence of death, grief and loss

• Provide education and coaching on how to build emotional resilience

• Normalize and develop awareness of grief and loss reactions

• Implement a Peer Mentorship program

• Offer check-ins and debriefings with staff following a resident death

• Develop a ritual to celebrate the life of deceased residents, include staff and family caregivers to offer an opportunity for closure

The culture of a long-term care facility is determined by how the organization supports staff in managing the emotional demand of their work. With the goal of improving staff retention and optimizing staff wellness, leadership in long-term care is well advised to offer frontline staff formal education and support in recognition of the emotional impact of their work.

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