Emerge Stronger: Helping Caregivers Heal When Patients Don’t

Program offers confidential, one-on-one peer support after distressing clinical events

Caring for eight to 10 critically ill patients at a time, respiratory therapist Mark Was is continually on high alert. Stress and emotion are all in a day’s work. But one particular patient encounter four years ago still runs through his mind today.

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“She was in her mid-40s, and she was dying,” he says. “The family wanted to say goodbye. But in order for her to be awake, she needed to be off of the ventilator, so I had to bag her, manually giving her breaths. One of the hardest things I’ve ever had to watch was her 8-year-old — who was the same age as my son — lying across her chest, just asking her not to go, begging her, and knowing that there’s nothing any of us could do.”

After two hours, his hands and wrists cramped, his mind fatigued and his chest heavy with grief, he put the patient back on the ventilator. She was sedated and eventually died. Was walked out of the MICU and headed outside, needing a few minutes to compose himself.

It’s for experiences like that and caregivers like Was that Cleveland Clinic has created the Emerge Stronger program. Emerge Stronger offers confidential, one-on-one peer support for any Cleveland Clinic caregiver distressed by an adverse clinical event.

Since the program started in 2020, nearly 140 caregivers in a variety of Cleveland Clinic roles have been trained as peer supporters. The goal is to train individuals from all areas of the organization, available to help any of Cleveland Clinic’s nearly 70,000 caregivers heal from the distress that can be a natural and sometimes unavoidable part of patient care.

Caregivers can request help through the program’s website or email. A program manager matches each caregiver with a trained peer supporter, who schedules a meeting with the caregiver either virtually or in person. Peer supporters listen, empathize and encourage, and follow up with the caregiver after their first meeting. They also can recommend resources for more intensive support, such as from counseling or spiritual care professionals.

You’re not alone: ‘Second victim phenomenon’ is common

“Often in healthcare, after these events, we suffer in silence and we suffer alone,” says Laura Hoeksema, MD, MPH, a Cleveland Clinic hospice and palliative medicine specialist who is heading the Emerge Stronger initiative. “We are committed to creating an environment in which caregivers can emerge stronger after distressing events.”

According to a study Dr. Hoeksema conducted before developing Emerge Stronger, 75% of Cleveland Clinic caregivers had experienced some kind of adverse patient event on the job. More than 80% of caregivers said the help they desired most after one of those events was support from a respected peer.

Dr. Hoeksema experienced that need herself nine years ago.

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“I was caring for a patient who died by suicide,” she says. “It was a really challenging time in my career. I spent years feeling guilty, wondering what I’d missed and how I could have prevented his death.”

Grief over adverse events is common and should be openly recognized, she adds.

“I wasn’t just grieving the patient’s death. I had to come to terms with how I viewed myself and my role in his death,” says Dr. Hoeksema. “I wish someone had been there to help me understand that the emotions I was experiencing and the questions I was asking were a normal, expected response.”

In patient safety literature, the concept is called “second victim phenomenon,” first characterized in 2000 by Albert Wu, MD, MPH.

“Just knowing that this phenomenon exists generates healing because we recognize that we aren’t alone in our experience,” says Dr. Hoeksema. “Had I known about second victim phenomenon, that time in my life would have been less traumatic.”

Supporters for every job function

Emerge Stronger was founded on the idea that healthcare professionals aren’t alone in feeling occasional distress. Dr. Hoeksema convened an interdisciplinary team, with contributors from throughout Cleveland Clinic, to design the program.

“After a distressing event, it’s helpful to talk to someone in the same role as you, someone who understands the challenges of your day-to-day job,” she says. “That’s why we match people by role. Health unit coordinators support health unit coordinators, nurses support nurses, and so on.”

Guest services navigator Arletta Roach is known for her people-loving nature and generosity. Her role at Cleveland Clinic involves personally connecting with patients, in the form of service recommendations and friendly conversation — and sometimes get-well cards and gifts.

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“I became close to one of the patients,” she says. “The last time I sat with him, he told me that he felt good and that he was going home. When I came back to work, they told me he had passed. I felt like I didn’t do enough. That was very emotional for me.”

Emerge Stronger peer supporters, including those with environmental services positions like Roach, now are available for similar situations.

“They give me the advice that I need, reassuring me that I’m not the only one who has been through something like this,” says Roach.  

Reassurance through the highs and lows of healthcare

According to Dr. Hoeksema, enhancing the environment of healing for caregivers enhances the environment of healing for patients. And that’s especially important at Cleveland Clinic and other medical centers that are constantly exploring new frontiers in medicine.

“We bump up against our limitations on a regular basis, and this has an effect on us,” says Dr. Hoeksema. “We see patients on their worst days. It can be fulfilling to work as a team to help them get better, but not all of them do.”

Healthcare is a mix of celebrating when patients heal and grieving when they don’t, she notes. The emotional highs and lows can take a toll. That’s when Emerge Stronger can offer reassurance.

“It may not resolve the issue, but just having someone to listen, understand and show that we’re not alone is important,” says Was. “There’s good stuff and bad stuff, and we’re all here together, no matter what.”