1. Brown, Theresa PhD, RN


A journalist investigates and offers a way forward.


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It's hard to imagine a more timely book on the topic of health care than Rachel Jones's Grief on the Front Lines: Reckoning with Trauma, Grief, and Humanity in Modern Medicine (North Atlantic Books, 2022). Jones, a journalist, dug deep into the trauma experienced by health care workers, in particular physicians and nurses, and in doing so discovered an abundance of frustration, misery, and extreme professional disaffection. She offers no easy solutions to the problems clinicians face. But the book's discussion of how poorly the health care system attends to the emotional needs of staff will likely leave nurses feeling validated and less alone.

Figure. Theresa Brow... - Click to enlarge in new windowFigure. Theresa Brown

Grief on the Front Lines details how damaging both nursing and medical school education can be. Nurses and physicians start their clinical careers having been acculturated into work environments where they're often overworked, judged unfairly, and held to impossible standards-all while being expected to cope with potentially traumatizing situations, such as gruesome injuries and deaths, and provide support to stricken families.


Such acculturation encourages clinicians to deny their own emotional vulnerability and spurn the very idea of mental health care. As a result, when they feel their ability to cope failing, they have very little idea of how to help themselves. Some health care workers disconnect from patients or even depersonalize them in an attempt to protect themselves from being traumatized by what they experience on the job. But according to the resilience experts whose observations pepper the book, disconnection can factor into burnout. Indeed, one researcher found that feeling connected to others was the only common driver of clinicians' sense of fulfillment. Commenting further, the researcher said, "Okay, how do we create connection?" Jones reports on one widely taught course for medical students, called The Healer's Art, that draws from psychology and the creative arts to support clinicians in bringing their humanity to work, noting that "while medical school is focused on delivering large volumes of information, most people choose the profession for heartfelt reasons." Similar courses for nurses also exist, and these programs necessarily incorporate connection as a key value.


While many of the clinician activists quoted in the book acknowledge the importance of self-care in maintaining resilience, they also note that the health care system itself constantly grinds nurses and physicians down. Electronic health records take up more and more of clinicians' time without making their jobs any easier. An institutional focus on maximizing profits undermines clinicians' ability to pay adequate attention to patients' human needs. Jones cites Stephanie Adler Yuan, director of programs at the Boston-based Schwartz Center for Compassionate Healthcare, who argues that systems change is crucial because "what healthcare staff are really suffering from [is] trying to provide compassionate care within so many systemic challenges."


Readers will come away from Grief on the Front Lines understanding that nurses and physicians are ultimately just people, not unstoppable superheroes who can face trauma and death daily with aplomb. That facade of invulnerability has shown small fissures for years, but it cracked wide open during the COVID-19 pandemic, as clinician burnout reached epidemic levels and numerous fed-up workers left their jobs. Jones spoke with Arif Kamal, a palliative medicine specialist at Duke Cancer Center in Durham, North Carolina, who observed that experiencing too much sadness and strain, without sufficient emotional and physical recovery time, can "introduce potentially some moral injury as well, which is this injury of over promising and under delivering." In other words, being unable to give the kind and quality of care they value most can also be a form of trauma for hospital staff.


Nurses, physicians, and ancillary health care workers want to keep working, and patients need them to. Our overly bureaucratic, revenue-focused health care system must find a way to prioritize care for clinicians as well as patients, if we are to ensure its continuing function. Grief on the Front Lines calls out the ways the current system fails clinicians, with abundant details and thoughtfulness. The book's messages should be impossible to ignore.