Healing with Code Lilac
Hospital program aims to reduce caregivers’ emotional stress
For Houston nurse Jeremy Williamson it had been just another day on the job. Except that it wasn’t.
His teenaged patient had died, and as he drove home from the hospital, he grappled with a grief that left him exhausted and empty.
“It was a whirlwind,” said Williams, an intensive care unit nurse at Children’s Memorial Hermann Hospital. “You feel the exhaustion. You feel the pain. It’s not what the patient’s relatives are experiencing, obviously, but it’s still there for you.
“Sure, you’re told these types of things will happen, but I don’t think you’re ever really prepared.”
Left unresolved, such feelings can fuel the burnout that drives up to one-half of new U.S. nurses out of their jobs — or out of the profession — within their first three years. That turnover costs hospitals millions of dollars and diminishes the quality of patient care.
Faced with the most devastating patient outcome, though, Williamson and his colleagues had been lucky.
Before they went home for the day, they were counseled and comforted by a team of nurses trained to defuse turbulent emotions. Williamson and the other team members were allowed to express their frustrations and sorrow. The session didn’t solve all the hurt, but it helped.
“Code Lilac,” the hospital program that trained the nurses, was launched in November 2015 by hospital Chaplain Glenda McDonald. The program aims to ease emotional trauma that could debilitate health care professionals.
Now, after 21 Code Lilac activations at the children’s hospital, Memorial Hermann administrators hope to expand the program to other hospitals in their regional network.
“In trauma hospital culture, we’re tough,” McDonald said. “We don’t need this touchy-feely stuff, but we do.”
At a hospital with more than 300 patient beds
and the region’s busiest pediatric emergency room, deaths are not uncommon. Health care providers labor to balance empathy with emotional distance.
“We have kids die here every day,” McDonald said.
Still, there are occasions when a professional’s self-protection dissolves. After six victims of physical abuse died in a short period of time, McDonald saw medical residents weep as they made their rounds.
“You know when this one, a death, is different,” she said. “You can see it on their faces when they walk out of the room. You can see everything is not right.”
McDonald, manager of the children’s hospital three-person chaplaincy staff, described the hospital as a “family.” “Our goal is to take care of each other,” she said. “This isn’t a job where your work an eight- or 12hour shift, then forget and go home.”
Code Lilac, she said, is an extension of an existing program, “Refreshing the Spirit,” in which quiet time regularly is set aside for hospital staff to broach job-related emotional stains with colleagues or chaplains.
Seventy-five nurses, trained by Bellville crisis intervention specialist Naomi Paget, volunteer on Code Lilac teams.
Paget, who has trained international relief teams as well as intervenors at hospitals and law enforcement agencies, said medical workers are immersed in the “most difficult scenes of trauma.”
“The constant attack on their own well-being is evidenced by their reactions to what they experience on a day-to-day basis,” she said. “Add in their own personal issues and crises away from work and you have a recipe for physical, emotional and spiritual exhaustion.”
In a profession in which stakes always are high, stress is omnipresent.
Half of nurses in one American Nursing Association study reported they were “exhausted and discouraged.” Another study found four in 10 nurses saying they would leave the profession within a decade. A 2010 study reported in MEDSURG Nursing, the journal of the Academy of MedicalSurgical Nurses, asserted that 30-50 percent of new nurses leave their first jobs, or the profession entirely, within three years.
Paget called Memorial Hermann’s Code Lilac “emotional first aid.”
McDonald, a Quaker clergywoman, said anyone affected by a patient’s death can call for a Code Lilac intervention. Such sessions, involving all the staff wanting to attend, take place before the hospital shift’s end.
“I really think the Code Lilac idea has been great,” pediatric ICU nurse Matt Varnum said. “It’s done good things for the hospital, good things for the nurses.”
Varnum, 31, is both a Code Lilac intervenor and a beneficiary of the program.
His moment of crisis came when his young patient, seemingly recovering, unexpectedly died. Such crises sometimes come after weeks or months of unacknowledged but growing stress.
“It seems to go in cycles,” he said. “There will be periods that they have a lot of really sick children. ... Then, it will hit you all at once.”
Williamson, 30, said he broadly was acquainted with the demands of nursing because his brother and sister-in-law are nurses.
“It’s much tougher than I thought,” he said. “It’s hard work. It physically and mentally takes a toll. There’s also an emotional aspect that I didn’t expect, especially working with children ... I don’t always not take it home with me. It does come home with you sometimes.”
Alyssa Summers, 27, a pediatric ICU nurse who also was present at the teenager’s death, admitted that on occasions of particularly traumatic events she doesn’t feel like going home. The mother of two young children, she acknowledges the difficulty in establishing the right relationship — neither too familiar nor too distanced — with patients and their families.
Summers was not the dead teen’s primary nurse, but the episode devastated her. As she entered the Code Lilac meeting after the teen’s death, she was in shock.
“I knew this was a safe place and I was glad I was there, but I wasn’t ready to talk,” she said.
Code Lilac nurses, she said, made a point of establishing eye contact.
“There was warmth and peace,” she said. “OK, this was a moment to talk and surface our emotions. This wasn’t about medical issues — what went wrong and what went right. It was about emotions ... I’m sure I was crying. It was my only time to get it out. Then I stepped back out there to take care of my patients, who had no idea what had happened in the next room.
“It was a very hard day, my worst so far.”
Without the Code Lilac intervention, Summers said, she likely would have continued to function as a competent nurse.
“There would have been something missing, though,” she said. “That heart connection.”