Highmark Caring Place lends a hand to nurses in need

Nurses who work with patients with traumatic injuries often are so overwhelmed by caring for them, they sometimes overlook family, especially children at the bedside who are trying to cope. 

And when they do stop and care for family, especially the young, the toll it takes on them can become debilitating. 

So said Mary Jane Bijelic, nurse practitioner for the Neuroscience Critical Care Unit (NCCU), lead advanced practice provider for the Department of Neurosurgery, Penn State Milton S. Hershey Medical Center. 

To compound the issue, COVID-19 struck and not only did the nurses have to work in fear of the unknown, they had to communicate with family virtually because everything was in lockdown, she said. 

“We didn’t know day to day if we were safe or would have enough PPEs to go around,” she said. “We had to be on the front lines caring for patients who were alone and scared with no family around. It was hard.” 

To help her staff, Bijelic reached out to the Highmark, which has 20% ownership of the health care system, for help and for the past five years, her intensive care unit and Highmark’s Caring Place in Lemoyne have been collaborating on a program to help nurses process their grief and loss so they can better handle the day-to-day work in their units.  

“After becoming a mom, I noticed that kids (visiting loved ones) were invisible to the staff. The nurses didn’t know how to deal with them and support them,” she said.  

While trying to find a solution to help the children cope with what they were seeing and feeling, she reached out to Terri Bowling, Highmark Caring Place manager for help.  

The Caring Place, created by Highmark 20 years ago, is a no-cost service for anyone who needs help processing the loss of a loved one. Through meals and therapeutic group sessions, families are able to know they are not alone and can learn to process their feelings, Bowling explained. 

The hospital program’s initial intention was to teach nurses how to care for family members, especially children who were seeing loved ones when they looked or acted very differently due to their injury or illness. Bijelic and Bowling quickly realized that the first focus needed to be with the nurses themselves. 

“You can’t take care of your patients if you aren’t processing your own feelings first,” Bijelic said. “So, the Caring Place works with us on how to deal with the grief of caring for patients.” 

“This is a great extension of the work we’re doing at the Caring Place,” Bowling said. “Mary Jane’s vision and passion was to change the core model of the workday and make a cultural shift.” 

The workshops teach nurses that they are not alone in their feelings and how they can handle moral distress, caregiver fatigue and how all of it carries through their personal lives, she said. 

Since the pandemic began, Bijelic said having the program in place helped nurses weather the uncertainty of day-to-day work life. 

In addition to talking about what they are experiencing, the program uses music therapy and chaplain services. Hershey Medical Center has a life care specialist that helps nurses learn how to care for children at the bedside as well, Bijelic said. “It lessens the trauma for them when they notice what the kids need,” she said. 

Bowling said the nurses meet regularly in small groups to share personal information. “It makes them a close team,” she said. That closeness allows them to offer each other more support. 

“I see people now stepping in to offer support or encourage someone to take a break if they are having a tough time,” Bijelic said. “Things are changing as people allow their issues to come out.” 

“We give them resources so when they need help, they know where to turn,” Bowling said.  

“The issue is health care in general,” Bijelic said. “When I was in school, we didn’t talk about this. We were basically told to deal with it and move on.” But it’s not that simple, she said. 

“It’s a big problem,” Bowling agreed. “Mary Jane’s unit has changed. They are very vulnerable. They live between life and death and have to deal on a human level,” she said. “They have no time to decompress and now we are giving them support for dealing with burnout and compassion fatigue.” 

The program started in Bijelic’s unit. It has now expanded to the Neonatal Intensive Care Unit and both Bijelic and Bowling hope to see all the ICU units in the hospital participate. 

“It’s a big challenge because of the way the staff works,” Bijelic said. Scheduling makes it hard for people to attend the sessions and COVID was a big roadblock, she added.  

She explained that the shortage of nurses and the long hours they work make it hard to attend full day workshops. “If we have 8-10% of the staff in a workshop, we have vacancies for the day,” she said. “But we know it’s worth it for the health of the staff.” 

“Many resources were pulled during the pandemic. Mary Jane is really driving this, and we are seeing nurses coming now that are so overwhelmed due to COVID,” Bowling said. 

But the program is working. “The nurses are learning to cope with their own grief and now they can be more supportive of grieving families,” Bowling said. “That is making a big impact.” 

Imagine, Bijelic said, “a child walks into the ICU and sees a loved one who just had brain surgery who no longer has hair and has a big scar. It’s scary.  

“Our nurses make stocking caps to hide it from the children now,” she said. “We have stuffed animals and make handprints to help get them through the trauma.” 

The program also utilizes a butterfly tree, a 24-inch white birch tree covered in butterflies that carry messages from nurses about their fears, traumas, hopes and wishes. The butterfly, Bowling said, is the international symbol of hope.