Rotating schedules, debriefing, and teaching “chaos therapy” have been suggested as ways to help emergency room personnel deal with the anxiety that can come from dealing with death on a daily basis. Share on Pinterest How do emergency room nurses cope – much less function – when they’re constantly surrounded by death? Some mentally shut down. “[They] just do their job, robotic-like,” said Christine Kovner, Ph.D., RN, a senior fellow at the Hartford Institute for Geriatric Nursing and a professor at the College of Nursing at NYU. “It’s possible to do a job that way, but down the road the nurse likely would face consequences.” Many others experience “death anxiety,” a state that makes them more conscious of their own mortality and creates a high level of stress and unease. An article in the journal Emergency Nurse calls for hospital leaders to recognize the signs and symptoms of this condition and put interventions in place to help improve the mental health of their staff. Read More: Nurses Are Overworked on the Front Lines »

Who’s at Risk? Nurses are especially vulnerable to the debilitating condition because of the nature of their work and the constant exposure to death, according to Mike Brady, a doctoral research student at Swansea University, lecturer at Open University, and clinical supervisor paramedic at South West Ambulance Service in the U.K. Kovner says it’s not just nurses. “They might be more at risk because of the amount of time they spend with patients, but I don’t know that they’re anymore likely to have issues than physicians, physical therapists, or other health workers,” she said. “There’s nothing inherent about being a nurse that would make them more susceptible.” Nonetheless, Brady says healthcare organizations must make nurses aware of the risks of the disorder, also known as thanatophobia, and provide staff with access to interventions to prevent the condition from affecting their physical and mental health.

A New Concept Although nurses may be well aware of the daily stress of the job and potential for burnout, Brady said in a statement that many emergency nurses and paramedics may be unaware of death anxiety, even though they’re exposed to it every day. Kovner said education is a key. “Nursing programs vary a lot across the country and vary in terms of how they teach and work with students around the issue of death and dying,” said Kovner. She said NYU’s undergraduate program does address the topic. Read More: What Do Employers Want in Nurses? »

Rotating Employees? Brady suggests organizations consider rotating emergency healthcare workers so they aren’t overly exposed to mortality. Healthcare administrators must also assess employees who are involved in critical cases against a trauma risk-management tool to see if they are at high-risk for death anxiety, he said. Kovner, however, is dubious that rotating would help. “I think people have to learn to deal with their work environment and, if they’re having trouble, they should obtain help from the organization, within the community, or make a decision to take another job,” she said. Kamienski added: “I think the idea of rotating individuals away isn’t a practical solution at all. The ED must be staffed 24/7. All ED staff must be prepared to encounter life and death situations as often as they occur. This is also true for oncology and ICU nurses, and neonatal ICU areas. It simply isn’t practical to say: ‘You will be reassigned today, so you don’t have to deal with these situations.'” Providing debriefing sessions after a traumatic incident is another way to combat death anxiety. Kovner suggests organizations conduct small, weekly group meetings for staff members perpetually around trauma. Professor Mary Kamienski, Ph.D., RN, a fellow of the Academy of Emergency Nursing and specialty director of the family nurse practitioner-emergency care track offered as a doctoral degree at Rutgers School of Nursing, said Rutgers fully supports the concept of debriefing employees following exposure to death or near death situations in, among other places, the emergency department. However, she thinks many nurses will resist this approach because they feel it’s mandatory to simply “move on.”