Caring for the Carers

With death and dying at the centre of every day's work, it takes a special kind of person to work at Auckland's Mercy Hospice. Jackie Brown-Haysom learns that by putting staff first, everyone benefits.

Jayne Huggard, who is part of the staff and family support team at Mercy Hospice Auckland, knows there's something special about her workplace. It's not the clause in the staff emotional safety policy instructing workers to "spoil yourself rotten, often". Nor is it the book vouchers that all employees receive on their birthdays, or even the emergency chocolate box for satisfying workers' late-night cravings.

What makes the hospice special, Jayne says, is the people who work there. "You wouldn't want to work in a hospice unless you were a special sort of person, and because all our team members are so special it makes it really easy to support them."

Jayne came to the hospice nine years ago as a family counsellor, but when CEO Jan Nichols discovered her passion for staff support "the role took on a life of its own." These days, while she still does some work with patients' families, staff support takes up most of her time. "I have a strong philosophy that if you put staff first and value them, the care our patients and families get will be superb. But if you put patients and families first, patient care will drop off because our people will feel unsupported."

Mercy staff quickly learn that the hospice is no place for stoicism. With death and dying at the centre of every day's work, emotional needs are openly acknowledged and everyone - from the clinical director to the volunteers who read to patients and man the drinks trolley - knows it's okay to ask for help when they need it.

"It's the organisation's responsibility to deal with work-related issues," Jayne says. "We don't want people taking these things home to their partners, or waking up at 3am worrying about them. We have a culture where it's okay to say you need extra help or support." Once a month every hospice worker - the 90 regular staff and 430-strong team of volunteers - is offered an hour of confidential professional supervision. This gives them an opportunity to sit down with a counsellor or psychotherapist and talk about whatever aspects of the job they choose - their workload, the patient who reminds them of their mother, a staff conflict, or anything else work-related that is affecting them personally.

While supervision isn't compulsory and is usually done outside normal work shifts for clinical staff, Jayne says people don't often miss a session, and management encourages its use by paying people to attend.

"It's what keeps us safe to do what we need to do. It's not about patient care - it's about ourselves as health professionals and the work we do. It creates a safe place where you can say you feel stressed or overwhelmed."

While Jayne and her fellow counsellors provide the supervision for nursing and administrative staff, the fundraising team, managers of hospice shops, and any volunteers who feel they need it, external providers are engaged to look after the counselling team and senior management.

"We work with the same people all the time so trust and confidence builds, and people feel safe to talk about all sorts of issues. Some people need help to recognise what their needs are, but when you ask the right questions there is always plenty to talk about."

Viv James, coordinator of the Opening Doors day-stay programme, went through a stage of believing she didn't need supervision, but is now a keen advocate. "It proved its value to me when I didn't have it," she says. "I got a bit cocky and thought I could manage without it, but now I realise that it's like massage for a runner - if you have it you don't get injured. I don't think you could survive in this job without it."

If a one-hour session is not enough, staff can book extra sessions, and if it is personal issues rather than work-related ones that are causing concern, there is the option of asking for EAP counselling, or an in-house session with a member of the support team.

"A lot of organisations avoid internal staff support because of confidentiality issues, but we've been doing it for years and have never had a problem. Some do go to EAP with their personal issues, but more come to us," she says.

Workplace stress relief doesn't always have to be booked in advance, however. If staff or volunteers find themselves struggling with a particularly distressing situation, they can ask for an immediate debrief session. "It's a formal process but anyone who wants to can come. Basically we just sit around and talk about what's happened. I find that by talking, and inviting others to add what they know, we can help make sense of things."

With an average of 60 deaths a month among its in- and out-patients, the hospice has developed its own rituals to ensure that each death receives formal recognition, and staff get a chance to farewell the people they have worked with.

"Each Monday we gather to light a candle, read the names of everyone who has died in the last week, and talk about what they meant to us. When someone dies in the hospice we put a butterfly on the door of the room and have both the room and the lift they went down in blessed."

Such rituals, Jayne says, are a "sustaining" way to acknowledge sadness and death. "Our people need to go to hard places and it is rituals, and the values that underpin what we do, that make them able to cope."

She traces much of the hospice's value-based culture back to its founders, the Sisters of Mercy. Although the order is no longer involved in day-to-day operations, there are Sisters on the board, and a director of missions from the order works closely with management to ensure that Mercy values are maintained.

"It's our values that make people want to work here," Jayne says. "I always say you can feel the love bouncing off the walls.

"Most of us aren't Catholic, but it is a very spiritual place. You probably could work here if you were an atheist, but it might be hard to maintain that belief, because there is a sense all the time that this is way bigger than us."

A few years ago Jayne made use of the six months leave without pay, which is on offer after five years service, to take a Churchill Fellowship studying staff support in Canadian and British hospices. She came back convinced that New Zealand was doing very well by world standards, and set about doing her own research to prove it, conducting an interdisciplinary staff survey at every hospice in the country.

"I asked what was important to them, and how good the hospice was at providing it. From the 500 responses it was clear that we do death and dying very well, and the areas where we need to do better are organisational ones, like rosters and manager feedback."

A particularly pleasing part of this research - which formed the basis of Jayne's recently completed master's degree in health science and palliative care - was that 93 percent of staff felt well supported by co-workers and line managers. Such mutual support is essential, she says, if the hospice is to meet individual needs.

"We aim to be flexible with our rosters so if someone has a sick child or whatever, there is never an issue about taking time off. Everyone else just pulls together and covers. From time to time people may need a duvet day, to just stay at home. Managers gulp and say ‘How are we going to manage the roster?' but they keep on doing it."

The emotional safety plan that sets the rules for staff care also provides for workers to have two weeks consecutive leave each year, and allows extended leave following a personal bereavement. Jayne acknowledges that these requirements can be a challenge to manage, but is confident that the end justifies the means.

"It's this sort of care that makes you want to get up and come to work in the morning. People often say to me 'How can you work there?' but I say we get looked after as well as the patients do. It's the best place I have ever worked, and I can't imagine working anywhere else."

By Jackie Brown-Haysom who is an Auckland-based freelance journalist.

We thank 'Employment Today', for allowing us to display this article from their August 2009 edition.