I started working in long-term care when I was in my early 30s and I was shocked at first when the residents died. I was used to falling in love with my patients — I consider it a prerequisite for psychotherapy. I wasn’t used to them dying on me.
In the years since, I’ve lost many, many people who have touched my heart, but I can still remember very clearly the ones who passed when I was new. In order to make it in LTC, I’ve protected myself by falling in love in a different way.
A recent New York Times article, “Is Giving The Secret of Getting Ahead?”, piqued my interest when it touched on the impact of death anxiety at work, suggesting that it could have an effect on absenteeism and turnover. Working with residents in LTC is all about coping with death, and facilities have huge problems with absenteeism and turnover —surely there was a connection. I raced through the article, located the research paper it mentioned, “The Hot and Cool of Death Awareness at Work,” and plowed through that too. What I read seemed very applicable to long-term care, so I’m going to present the gist of the research and ways to reduce absenteeism and turnover based on these ideas.
In “The Hot and Cool of Death Awareness at Work,” authors Grant and Wade-Benzoni outline different types of work where mortality cues can be chronic or acute, internal or external to the job, and personal or vicarious. A firefighter, for example, is constantly in a work situation that threatens his life. This would be considered a chronic, internal, personal mortality cue. A nursing home employee would have a chronic, internal, vicarious mortality cue because they are repeatedly exposed to other people at work who are dealing with end-of-life issues.
Reactions to mortality cues
The authors state that there are two different reactions to being aware of death at work. A “hot” reaction leads to self-protection and “stress-related withdrawal behaviors” such as absenteeism, tardiness, and turnover. A “cool” reaction leads to prosocial behaviors such as helping, mentoring, and thinking of work in the context of contributing to society. They refer to the hot reaction as “death anxiety” and the cool reaction as “death reflection” and note that chronic exposure to mortality cues can shift a worker from death anxiety to death reflection.
This shift from death anxiety to death reflection describes my experience as I continued in long-term care. It also explains why some new workers bail out early and others persevere to become beacons of light in a challenging environment. In addition, the researchers propose that as we age, we become more likely to experience death reflection rather than anxiety. Younger workers, therefore, are more likely to withdraw from the nursing home environment.