Life, death and serenity at work
BACP Workplace, January 2025

Do you remember how often during the pandemic we were shown the incredible work that healthcare professionals were doing? While many of us stayed at home, their job was to look after people with care, concern and compassion, including those infected with a deadly virus. It is work that touches the heart of those who deliver it. And, of course, being faced with these news stories on a daily basis, we felt for them too. Now that the cameras have turned away, we’ve turned our focus elsewhere, yet their work continues.

These professionals spend the majority of their life at work, which means they devote their lives to looking after people for weeks, months and sometimes, years – developing close relationships and supporting them until they take their last breath and even, after death. Sadness, loss and grief are all a part of the work, and they still have to get on and look after their next patient – day in, day out; it is a relentlessly difficult job. 

Fact and figures 

According to research by The King’s Fund, there are 1.5 million NHS and community health staff, and 1.5 million working in adult social care in England.¹ In 2023, the Office for National Statistics (ONS) reported that there were 581,363 deaths² registered in England and Wales; and, of course, behind each number is a person who will, in all likelihood, have needed care and support in the last years of their life, probably delivered by a number of health and social care professionals who will have accompanied them on that journey. And it takes its toll. 

Inevitably, working with death and dying as part of the day job affects the wellbeing of all staff in end-of-life and palliative care, including care assistants, palliative care doctors and nurses, physiotherapists, social workers and psychologists. This is often recognised by compassionate, well-informed care home managers, palliative care service leads and hospital managers who have legitimate concerns for the wellbeing of their teams, their mental health and the high risk of burnout. 

Moral, ethical and business case 

A key finding in the Care Quality Commission’s (CQC) latest report, The State of Healthcare and Adult Social Care in England 2023/24,³ was that staff regularly reported being overworked, exhausted and stressed, sometimes to the point of becoming ill, injured or leaving their job altogether. 

Furthermore, the CQC report states that the quality of care that people experience is affected by many different factors, and increasing demand and pressures on staff are taking a toll on their mental health and wellbeing.³ Staff have reported that, without the appropriate support, the quality of care they deliver to patients is being affected. Indeed, between 2020 and 2022, NHS staff have been more than twice as likely to record ‘anxiety, stress, depression’ as the cause of their sickness absence than any other reason.³ This accounts for 20% to 28% of all sickness absence.³ Over half of respondents to the CQC survey of adult social care providers in England, said that they were having challenges recruiting new staff and 31% said they were having challenges in retaining them.³ 

It’s a familiarly bleak picture and in the current economic climate, we don’t have budgets to pay for luxury away days for staff or loyalty schemes – but nor do we need them. Instead, staff need help to process their challenging professional lives, to learn and practise techniques that will help them, and also ensure that our workforce is sufficiently emotionally and psychologically healthy to withstand the daily turbulence of the work. Once these techniques and practices have been learnt – they are, of course, free. 

Rooted in experience 

I’ve been working with death and dying for over 20 years. I’m a health psychologist working in the NHS as well as private and charitable organisations. I started out as a healthcare assistant to support myself through university and training. I will always remember my first job in a nursing home and having such a lovely relationship with Gladys, and turning up one day to be told in a handover that she was dead. Nothing further was said and I was told to make the bed up for Peter who was arriving that day. It was shocking. And I was so sad.  

After I qualified, I worked in the NHS but my mum’s death was a turning point. She was only 67 when she had a severe stroke that ultimately ended her life. She had made no plans and we’d had no conversations about what she wanted at the end of life, where she wanted to be cared for, where she wanted to die, what kind of funeral she wanted and what she wanted to do with her estate – this will be a familiar story for many. 

So, in 2011, I set up Gentle Dusk, an organisation helping healthcare professionals and NHS staff to get comfortable with having conversations about death and dying, and offering training in end-of-life care planning and bereavement, as well as running Death Cafés for whole teams. During the pandemic, I delivered an end-of-life care service to twice as many people, with no increase in resources. But in my personal life, I experienced a series of hard life events: my father had a stroke and died, my daughter became critically ill and my partner was diagnosed with leukemia. You couldn’t make it up! I had to dig deep. And it ended up being a beautiful gift – I really did have to find the serenity within. 

True self-care 

We so often talk about #self-care. But I wonder, how many of us actually do something about it? And, do we really know how to do self-care or even what works? So, I took the bull by the horns and booked myself onto a science of wellbeing course at Yale University, and began to research the psychological tools for increasing wellbeing. And I practised it all on myself – day in, day out until I could cope well. I’m pleased to write that I’m now on the other side – life is still chaotic and sometimes I struggle but I keep coming back to the techniques to reset myself and reconnect to my serenity. And I want to share what I’ve learnt with others, which includes emotional awareness, techniques to support emotional wellbeing, and a deeper understanding of how to have open conversations about life and death. 

The missing ingredient 

Death and dying are not a part of the training that most healthcare professionals receive. They are trained to make people better – a success is the continuation of life, prolonging life and the focus is often not on ‘a good death’, but sometimes focusing on treatment and intervention to the detriment of ‘a good death’. We live in a culture that is death denying, where death is not talked about enough, and the time and space is not given to the inevitable – that we all die, and healthcare staff more than most, will experience a lot of death, repeatedly. It’s my belief that we should recognise the true value of the work involved in helping people to die well, and properly support the professionals with their normal, human responses to death and dying. 

According to research by The King’s Fund, there are 1.5 million NHS and community health staff, and 1.5 million working in adult social care in England²

In wider society, crying is still met with some discomfort and seen as a sign of ‘weakness’ – yet crying at someone’s death is simply a part of our humanity. Choosing to enter a career in care, end-of-life care or any demanding healthcare role, is often made because we are compassionate people, and we want to bring relief and comfort to others, particularly in times of distress. It is therefore normal to get upset, to be sad and deeply affected by what we do. 

Systemic change 

While some staff may receive limited supervision (only a small number), others may have team meetings to review and discuss ‘cases’, but there is little support available for them to actually look at how they are coping and how they are feeling. Multidisciplinary meetings are likely to focus on the patient, instead of how staff are dealing with the stresses, the losses, or the challenging thoughts and emotions which are frequently caused by the nature of the work. 

In 2023, the Office for National Statistics (ONS) reported that there were 581,363 deaths² registered in England and Wales

If staff become unwell, they may be referred, or self-refer for short-term counselling, but by then, they may also be suffering from debilitating anxiety and depression, off sick, and may not want to engage in one-to-one counselling. So, there needs to be a wider organisational approach, an upstream intervention to teach staff to learn to use tools and develop practices that will help them to process the continued challenges they face in their roles, and enable them to develop their own resilience and positive mental health approaches. Ultimately, this will result in healthier staff and better care for those who need it. The following account is an amalgamation of stories typical of those that I so often hear from healthcare professionals. 

All in a night’s work 

It’s a light October morning and Karen, lead nurse in the hospital psychogeriatric ward, and healthcare assistants, Sam and Kelly, are just finishing the night shift. The lovely Joy who has been with them since July has asked for her early morning breakfast. When she arrived, Joy was under chemotherapy for her cancer and experiencing some severe side effects, and the team treated her for sepsis. 

Joy wants to live, and she wants to make the most of her life until that isn’t possible anymore. The healthcare team nursed her back to health and by the beginning of October, Joy was well again, able to walk and was about to be discharged. She had a plan and was supported by the palliative care team who all knew her well, and had developed a lovely connection with her over the past few months. Joy was going to return to her cancer specialist, and ask for another round of chemo to enjoy her life and her relationship for as long as possible. 

Between 2020 and 2022, NHS staff have been more than twice as likely to record ‘anxiety, stress, depression’ as the cause of their sickness absence than any other reason³

This accounts for 20% to 28% of all sickness absence³

At the end of the night shift, Kelly rushes to Karen asking her to come to Joy’s bedside as Joy can’t swallow her breakfast and she is choking. The team try everything to dislodge the food in her throat, Joy’s heart stops so they try cardiopulmonary resuscitation, but nothing works. Joy dies. 

The staff are devastated, they are in shock, in grief. Sam and Kelly are only in their early-20s. They have never experienced such a raw death before. It’s the end of the night shift so they just go home, in tears. Karen needs to stay on to hand over to the team, and call Joy’s partner and tell him the difficult news. Then she goes home to take her children to school. There’s no one home as everyone has gone to work. How should Karen, Sam and Kelly cope with their emotions? How can they settle down and go to sleep? And how do they wake up, return to work and start all over again? 

Learning new ways 

When your work involves caring for sick people and dealing with life and death on a daily basis, your employer needs to recognise the potential impact this can have on your wellbeing and provide appropriate support. At Gentle Dusk, we have developed a programme that enables professionals to learn, experience and practise techniques that they can use to process trauma and distress, and also support their own wellbeing. It’s called the Life, Death and Serenity Programme, and it brings together state-of-the-art research on emotional processing and wellbeing; and the experience of working in traumatic, stressful and emotional environments, including working in end-of-life care, palliative care and the specific challenges this poses. 

Instead of PowerPoint presentations so often used in workplace trainings, we offer time, care, reflective space and the personal experience of our evidence-based serenity tools. The immersive sessions include evidence-based tools to regulate the nervous system, such as breathing techniques and meditation; scientifically proven psychological processing techniques which use specific trauma writing techniques; as well as emotional processing tools to help understand and manage the depth behind feelings, and express them within a non-violent communication approach. We also offer group space to have open conversations about death and dying, and encourage individual staff to work on their own end-of-life planning. 

It's affirming to hear positive feedback from hospital palliative care teams and care home professionals, who have described it as being ‘an emotionally enriching discovery’ and ‘an intense release’. It’s also good to hear that staff are using the new techniques they have learned, not just for their own wellbeing but also to share with patients. 

In the case study described earlier of how Karen, Sam and Kelly felt, they would have learnt to use the techniques to process their very difficult loss and distress from Joy’s death. It’s not unusual for teams on our programme to talk, cry, hug and then leave with a smile. Others will find the value of using the techniques to process difficult personal experiences, such as divorce or relationship issues which inevitably will impact how they feel at work. It’s humbling to witness the difference it makes to staff. Often, I share with them my motto, ‘Grant yourself the serenity you wish to offer to others. The kinder you are to yourself, the kinder you can be to others.’ 

Closing thoughts 

You’ll have gathered by now that I’m a firm advocate for having more open and honest conversations about death and dying, to help create systemic change and develop more compassionate workplace cultures for those whose work involves caring for people at the end of their life. For workplace counsellors and psychotherapists who share my interest in supporting better emotional and psychological health at work, I’d encourage you to create your own pilot programme in your organisation. 

If I had a magic wand, I’d ensure that every single team working in an environment where repeated exposure to death and dying is ever present, receives regular opportunities away from their workplaces to share their experiences in an informal but supportive setting. They’d have space for discussions, learning together, and experiencing evidence-based wellbeing techniques and tools to help them to process their emotional stresses. I think this should be mandatory – just as lifting and handling and infection control training is mandatory. 

Impaired wellbeing can only reduce compassion – they are closely linked. You can’t feel compassion for others when you are preoccupied with anxiety, exhaustion and depression. A nurse with burnout is unable to be a compassionate nurse and this has consequences for patient outcomes. When the workforce holds the tools that can bring serenity, employers will have better communication, collaboration and teamwork, as well as better staff retention, productivity, fewer sick days, and better patient care and patient outcomes⁴ – even if that should mean, ‘a good death’.