Listening to our collective groan: How spiritual direction brings healing to nurses
Photo by Emily Turner, Dallas Arboretum and Botanical Gardens
He gave her water each day when she was thirsty - the last week of her life. He quietly navigated all of our questions and personalities. He made it looks easy. So much knowledge, so many nuances. How much longer? What do you think? What does this mean? Why is she breathing like that? When will we see the doctor? What should we do?
He gently placed a cool towel on her clammy forehead in between monitoring her vitals, giving her tiny bits of water when she could manage. What would you do if you were in our shoes? We asked. The end neared.
He never made us feel like a burden.
Connecting all of the pieces, coordinating her care. Some of this was part of his job. but I realize now much of his guiding attentiveness was a bonus, a gift. His presence during the final days of my grandmother’s earthly life was holding our family, holding in the way a mother or father holds a child. The emotional and spiritual care his presence offered to her family wasn’t in his job description yet integral to my immediate and extended family including my grandmother as together we journeyed during her last days.
He is a nurse.
Soft-spoken and knowledgeable, Gene will enter my thoughts in unexpected times, and I always feel a wave of gratitude rush over me.
Gene and the compassionate care he gave to my grandmother felt present the past few days as I prepared to write this article. The pandemic hasn’t spared any of us in terms of loss. We have all been touched in some way, and frontline workers like nurses have been especially impacted.
It was an honor to visit with friend and fellow Spiritual Director and Registered Nurse Tamara Ramirez and her colleague and friend Phyllis Morton who is also a spiritual director and RN. They shed some light on the realities facing nurses as well as CODE YOU, a ministry they’ve co-founded that offers healthcare professionals holistic care as they face feelings of apathy, isolation, and compassion fatigue. If you’re a nurse or frontline healthcare worker, my hope is you might connect with resources that provide you renewal and respite. And if you’re not a nurse or healthcare worker, perhaps this interview might give you more insight into those who have been serving in hospitals during the past two years and beyond. Let’s continue to learn about the experiences of others.
Retreat House: Why Code You?
Tamara: Healthcare workers, specifically nurses have been struggling for some time now, but with COVID, the burnout and compassion fatigue rate has gone through the roof. Phyllis and I wanted to find a way to care for healthcare professionals and nurses. We’ve noticed that the existing programs for nurses don’t really incorporate a spiritual care piece. Code You is a continuing education course for nurses - a course really focused on spiritual soul care. The deployment of the course is very flexible. We want to keep our model accessible. We can offer ZOOM and in-person, and we’ll tailor the offering based on a group or individual’s need. We are also really happy to be able to offer nurses CEU’s (continuing education units). through Code You.
Retreat House: What brought you to the point of creating this program?
Phyllis: Tamara and I were both in a hiking group with women called dessert mothers. We do a contemplative hike almost every week. We have a little devotion and then we walk in silence. There’s prayer, too. When we met, we realized both of us had been trained at Perkins in their spiritual direction program. Tamara joined the hiking group right about the time COVID went crazy, about two years ago. This is when we began to think, what can we do?
Retreat House: Why is spiritual direction significant to this work?
Tamara: As spiritual directors, we have the ability to resource. We are many times the first safe place, the first step in the healing journey. Listening is a powerful thing. We don’t go on record. We will go on record if you need a resource, however. I spoke with a nurse who was suicidal so I immediately spoke with her – she knew, but she needed someone to say you need to get some help. I ended up referring her to a counselor.
“Nurses have shared with us that they need to have a voice. They give their patients a voice all day long. Spiritual direction is all about listening, and by listening and validating we can tell nurses that we hear what they’re saying. This kind of listening is powerful. ”
Retreat House: How would a nurse know if they’re burned out?
Phyllis: I remember a nurse who worked in an oncology unit. I remember how fatigued and depressed she was acting and felt. She wasn’t in a place to be taking care of others, but there is rarely someone to tell. Someone in this state has no business hanging an IV or being on a code team. Nurses are like military people. They need counseling, or a place to process all they are seeing and experiencing in their work. Not everyone is going to be okay all of the time, and there has to be places where people are allowed not to be okay. We hope the spiritual direction component offers this. Chaplains can sometimes provide this space but since they are working alongside the nurses many times these relationships are too close. If you don’t think you are okay, then you probably aren’t. There are signs of burnout that can help someone identify what they are experiencing.
Retreat House: I know you are both nurses so you are privy to this particular need, but will you explain to the rest of us why there is such a need for nurses to receive spiritual care?
Tamara: Nursing is a full embodied career. Nurses meet both the psychosocial and physical needs of a patient, and they are also expected to meet needs of a patient’s spiritual well-being.
Many times nurses don’t even have time to go to the bathroom during shifts let alone process the losses they experience as a direct caregiver. If you don’t have time to go to the bathroom or eat, the idea of engaging in spiritual practices doesn’t seem possible. But the reality is there is no way to develop a resiliency and true holistic health in nursing if you are not caring for the spiritual aspect of your health.
Retreat House: Will you provide some insight on how your curriculum offers spiritual care? What does it look like?
Tamara: We worked from the standpoint of the book When Faith Becomes Sight: Opening Your Eyes to God’s Presence All Around You. The book talks about recognizing God, reflecting on God and responding to God. We bring these questions into the course. And we use these questions in a way that creates safety for people of all faiths or none. Someone might be more comfortable using other words for God like Source or Divine Presence or Love. We create a space of hospitality and freedom of language.
During the course, we invite nurses to notice something during their workday. We ask them to consider a moment. We call them snapshot moments. You might take this moment and reflect on recognizing God in this moment, and then reflect on God, followed by considering how you might respond to this moment. It just has to be one moment — engaging in snapshot moments like this can become a spiritual practice. Nurses carry so many stories, and the stories can manifest in physical pain if they are not released. So we also talk about releasing some of the moments, too. Alot of these things can even happen in your car before driving home. Some examples include:
Grasping the steering wheel tightly
Reviewing your day - take note. What are you holding onto?
Slowing exhale and say letting go
Dropping your shoulders, arms and hands to your knees
Sitting for at least 30 seconds relaxing your body
Retreat House: I know Code You focuses on a spiritual care plan for nurses. Tell me some more about that.
Tamara: Whether it is a retreat, or a ZOOM where we meet on a regular basis, nurses who goe through a Code You course create a spiritual care plan tailored to them throughout our time together. It is a takeaway that they can implement on their own indefinitely. A spiritual care plan might focus on some of those daily release practices we just named as well as other practices. It is usually helpful to consider practices on a daily, weekly and monthly rhythm. These plans focus on the integrated self which consists of the heart, mind and body.
“A spiritual care plan requires thorough assessment, deep vulnerability and a desire to discover the Sacred.”
Phyllis: Nurses do so much. This is so important that we address the spiritual care part of them. I remember when I first started as a nurse more than 30 years ago, we did it all. There weren’t chaplains back then. Nurses were prepared to do oil and prayer, baptize and even pronounce. We have seen some of these roles come back into play during the pandemic, because other members of the care team aren’t always available. There is a considerable amount of stress on nurses right now, because they aren’t trained to do these other things but there is an expectation right now that they step up and perform.
Retreat House: What do you want people to know?
Tamara: I have two friends working in the ER. One is a nurse and one is a doctor. They are heartbroken. Many times these healthcare workers are separating the Covid patients from their family for the last time. You know they probably won’t make it out, but you can’t tell the family that. Nurses are doing whatever they can. They are facetiming patient families so they can say goodbye. They are also the first person that gets punched at, yelled at. You are in the midst of pouring out all of yourself for these families, for someone you don’t know and then you get beat up on. And this happens from administration, too — telling nurses they need to work more when they’re already exhausted. The system is so overloaded.
Even before the pandemic, we saw nurses leaving at an alarming rate. Many do not make it past three years out of nursing school. We are hoping Code You addresses a need that has been present long before Covid times.
Phyllis: There have been quite a few articles published recently showing that nurses on the front lines are showing the same post traumatic stress disorder (PTSD) symptoms as military people who come back from combat. One big difference is that nurses come home to their families at night and are forced to toggle between both of these worlds. This creates a lot of stress, because it is nearly impossible for their families to understand. When someone is at battle, they just stay at battle.
Our trainings not only provide nurses with a spiritual care plan but also community. We had two oncology nurses. It was really lovely, because they could understand each other, turn to each other and recognize God in the other.
Retreat House: What is next for Code You?
Tamara: In addition to offering training for nurses, we have developed a training for spiritual directors. The training provides specific resources and tools to work with nurses in spiritual direction. We are kind of moving to a train the trainer model. We just finished up a training with more than 300 nurses at Methodist Health System in San Antonio. We are looking to partner with organizations like this.
Retreat House: How has this been healing for you?
Tamara: When I started hiking with the group Phyllis mentioned in 2020, I noticed a sort of collective groan amidst the other nurses in our group. We shared the pain of burnout and the pressures that come with this work. Phyllis had been toying with this idea of combining her knowledge of nursing and spiritual direction.
And, after we did a study together on When Faith Becomes Sight, we began to see how things might fit together, how we as nurses and spiritual directors might offer healing to other nurses.
Alot of healing happened through my writing. When I wrote my sections for Code You on recognizing God, I was able to recall really hard spaces in my career. Through the writing and recall, I saw the beauty in these spaces, and now I’m able to connect in a really meaningful way with the nurses we are working with - because I’ve been there. I’ve been burned out.
Retreat House: I’m so grateful for this work you are doing. It seems to be part of your call and also something that is filling a great need. Is there anything else lingering before we go?
Tamara: I want people to know that it is our desire to prevent further burnout, compassion fatigue and moral injury to healthcare professionals. I like to say we are resuscitating nurses’ hearts to a sense of presence in the midst of pain.
The National Academy of Medicine reports burnout rates this year as high at 54 percent among nurses and physicians. Yet, even prior to the Covid pandemic, many health care providers were experiencing burnout, compassion fatigue, and even, moral injury.
As I think back to Gene, my grandmother’s nurse, I wonder now — who did he turn to to process all of the stories he was absorbing? He provided spiritual care, emotional care and physical care not only to his patient but spiritual and emotional care to her extended family.
We must ask ourselves how health care providers can be expected to provide holistic care to his/her patients without having all of these needs met for themselves first?
Learn more about Tamara Ramirez and Phyllis Morton and Code You here.
You can also sign up for upcoming offerings or regular communications from Code You. New to Retreat House Spirituality Center? Email us to receive our regular communications.
This article was written by Emily Turner. Part of Emily’s ministry and desire is to facilitate spiritual and emotional healing through listening, loving presence, prayer, and writing. She is a trained spiritual director. Learn more about her ministry.