Tending Together
Sky and clouds are reflected in a building’s glass facade, representing the transformations and new perspectives that emerge through grief
“What I know about living
is the pain is never just ours.
Every time I hurt I know the wound is an echo,
so I keep listening for the moment the grief becomes a window,
when I can see what I couldn’t see before
through the glass of my most battered dream
I watched a dandelion lose its mind in the wind
and when it did, it scattered a thousand seeds.
So the next time I tell you how easily I come out of my skin
don’t try to put me back in.
Just say, “Here we are” together at the window
aching for it to all get better
but knowing there is a chance the worst day might still be coming…”
-Andrea Gibson, Take Me With You
The Weight We Carry
There’s a kind of heaviness in the heart that healthcare professionals carry—a weight that may not ever announce itself, demand acknowledgement, or bear witness from colleagues or leaders. Professional grief differs from personal grief experiences because it is an anticipated result of the chosen job, and comes with the responsibility to attend to workplace demands rather than process emotions. This disenfranchised grief occurs when the loss is unacknowledged, cannot be publicly mourned, and is not socially supported. This grief is hidden in plain sight across healthcare settings where healthcare workers carry the impact of this heaviness through patient encounters, treatment team meetings, leading healthcare teams, and working with grieving families.
The healthcare environment often discourages open expressions of grief, viewing this universal human experience as lacking professionalism. When healthcare workers face cumulative losses, and this grief goes unaddressed, it can lead to complicated grief, compassion fatigue, emotional blunting, increased absenteeism, depression, anxiety, PTSD, and even workforce departure. These outcomes impact both the workforce and patient outcomes when healthcare workers’ grief goes unacknowledged and the human need for emotional expression to foster resilience is not validated.
Professional grief in healthcare is influenced across individual, interpersonal, and systemic factors, and it’s not always about death. Grief compounds with every patient loss, witnessing prolonged suffering, facing ethical burdens when navigating underresourced systems, and every policy decision that betrays our values in caring for others. Healthcare professionals care for others while navigating personal and professional grief, and anticipating grief. We keep moving, showing up, and doing the best we can all while grief remains as an unspoken occupational hazard we’re expected to absorb under “other duties as assigned.”
Between 2016 and 2022, I led a homeless program offering a continuum of services from street outreach to permanent supportive housing. Throughout 2020-2021, during the height of the pandemic, each day brought challenges in navigating inadequate resources, ever-shifting guidance, and ensuring the safety of team members and vulnerable Veterans whom we were serving. We lost Veterans we’d worked alongside for years. These were people whose names we knew, whose stories we carried, and whose deaths in isolation deprived them and their families of meaningful goodbyes.
There was the loss of colleagues who left the workforce due to workplace safety concerns, some became disabled from COVID complications, and those who could not risk bringing infectious disease home to their loved ones who are immunocompromised. There was my own body’s betrayal with Long COVID that persists, a reminder of the larger, collective institutional betrayal experienced as our team advocated for PPE, team members faced barriers in requesting reasonable accommodations, and workplace safety guidelines were constantly changing and not consistently enforced. That grief was relentless and compounding.
Grief doesn’t have an end date, and it doesn’t disappear in a single breakthrough. When grief compounds, we might notice difficulty with concentration, short-term memory, staying motivated, and feeling safe. After repeated losses, we may find ourselves constantly expecting the next bad news. Our nervous system is overwhelmed and under resourced. This grief lives in the body like muscle memory. This is the grief so many of us know intimately but rarely name it.
When Grief Becomes Cumulative
Cumulative grief—sometimes called compound grief—occurs when losses stack upon one another before we've had time to process the previous one. In healthcare, this is our norm, not our exception. A patient dies. A policy change that we know will harm the populations we serve. A colleague leaves, burnt out and no longer feeling connected to the meaning of the work. The system fails another person who deserved better. And we return the next day to do it again.
Each loss adds complexity and another layer. Physically, we feel it in our exhaustion, our compromised immune systems, our stress-related illness. Emotionally, we oscillate between numbness, anger, and overwhelming sadness. Cognitively, we struggle with focus, decision-making, and memory—that discombobulated feeling of moving through thick mud in the fog. Socially, we become irritable or withdrawn, unable to connect with others over topics that typically would bring us joy and unable to explain to those outside healthcare why we can't just "leave work at work."
We grieve what was and we grieve the future we were working towards—the one where our efforts would actually lead to healing, to justice, to change. We grieve the loss of safety and belonging when our institutions fail to protect us or our patients. We grieve our own identities as helpers when we're forced into harm, when moral injury fractures our sense of who we are. We grieve the routines, contingency plans, safety nets, and communities that once sustained us when staff turnover and system collapse leave us isolated in the wreckage.
When Anticipatory Grief Meets Cultural Dissonance
Anticipatory grief takes on a particular edge for healthcare workers (and anyone who cares about infectious disease and community health). Childhood vaccination rates are declining across the United States. COVID-19 remains the second leading cause of death in our nation. The CDC has ended its emergency response for H5N1 influenza (bird flu) and limited tracking of infections in both humans and animals. By January 2026, the US risks losing its measles elimination status, with over 2,000 confirmed measles cases as of late December 2025 CDC data.
We know what's coming: increased demand, decreased staffing, absenteeism due to illness, and the predictable surge of preventable illness and deaths.
There's a profound dissonance in this moment (or the last six years of this mass disabling event). Cultural narratives insist the holiday season be "merry" and filled with "joy" while our hospitals and nursing homes face the reality of overwork, understaffing, and underresourcing. We're told to “return to the office” where people are gathered indoors, symptomatic children are sent to school when parents no longer have the work from home flexibility, and people push through illness with a false sense of care in trying to reassure their disabled or immunocompromised co-worker, friend, or family member with, “don’t worry, it’s not COVID.” There is a lot of unspoken grief and harm that comes with the hyper normalization in dismissing public health science and minimizing or ignoring others’ health and safety needs in favor of economic productivity, seasonal tradition, or some other external expectations for comfort and control.
Over the past six years, we've witnessed the disruption—and in many cases, the deliberate dismantling—of systems, leadership, and public health advancements that once protected us. We are more vulnerable now to preventable infectious disease outbreaks, more likely to see our healthcare systems overwhelmed, more at risk of collapse.
Healthcare workers know this. We anticipate it. And we grieve it before it even happens, while it's happening, and after—when the losses are tallied, data disappears, and the world has moved on.
Finding Anchors: Reflection, Ritual, and Relationships
In the midst of these waves of grief, we need anchors. Three evidence-based practices can help us navigate without drowning: reflection, ritual, and relationships.
Reflection creates space to acknowledge what we're carrying, making sense and learning from it. This isn't about "processing" our grief on a prescribed timeline because grief doesn't work that way. Instead, the process of reflective practice involves looking back, finding meaning, and looking forward to the future while carrying the lessons learned. This process is about helping healthcare professionals thrive by contributing to their wellbeing, professional growth, and validating their value, worth, and experience. Journaling, grief check-ins during supervision, or simply pausing to name what we've lost can prevent grief from hardening into bitterness or numbness. Research shows that expressive writing about emotional experiences can improve both psychological and physical health, particularly for those in high-stress professions. Reflective practice is a common recommended strategy to prevent and reduce the impacts of vicarious trauma.
Ritual gives grief a shape, a container, and helps facilitate reintegration. Rituals vary in whether they are long or short term, and can vary in degrees of formality or informality. In healthcare settings, this might look like team debriefs after difficult cases, memorial ceremonies for patients lost, or end-of-shift practices that help us transition from professional to personal space. Chaplains tend to conduct these rituals and can be strong partners in supporting healthcare teams after a patient's death. Rituals don't erase grief, but they provide structure for honoring it collectively and helping reframe and integrate their understanding of the experience, promoting compassion and reinforcing shared humanity. They tell us: this mattered, you matter, we see what was lost.
Relationships remind us we're not alone in the weight we carry. Peer support, mentorship, and authentic community within our workplaces can buffer against the isolating effects of cumulative grief. When we share our experiences with others who understand—who've felt that same discombobulation, that same moral injury—we find validation, and build solidarity and resilience. Studies on healthcare worker wellbeing consistently show that strong workplace relationships are among the most protective factors against burnout and compassion fatigue.
Institutional Responsibility: Beyond Individual Resilience
Here's the truth we need to speak plainly: individual coping strategies are not enough when the system itself is the source of harm. Healthcare leaders and administrators have an institutional responsibility to create environments that not only expect workers to endure grief but also actively support them through it.
This requires more than resilience workshops and wellness apps. It demands trauma-informed leadership, structural change, and cultural transformation. Comprehensive strategies must include education about professional grief and the impacts, policies promoting wellbeing and support programs, dedicated time and space for grief management and supportive reflection, and participatory approaches in healthcare professionals collaborating with their leadership in mitigating risks from workplace exposure and improving patient care outcomes.
Here are concrete actions institutions can take:
1. Create protected time and space for collective reflection and debriefing. Build it into the workflow, not as an optional add-on. After critical incidents, policy changes, or periods of sustained crisis, provide facilitated opportunities for teams to process together. This isn't about "getting over it" or accepting “it’s just part of the job”—it's about preventing cumulative trauma from becoming hypernormalized and harmful.
2. Establish meaningful rituals that honor loss. Develop organization-wide practices for acknowledging patient deaths, staff departures, and systemic failures. Make grief visible and legitimate within your institutional culture. This might include memorial services, pause practices, annual remembrance events, or change initiatives. We can cultivate care, create meaning, and take lessons learned from patient deaths, staff losses, as well as from the policies and practices that need to die or change. Adopting and integrating change can be facilitated through acknowledging the end of life even for policies and practices. Consider incorporating a “death doula” approach to offer emotional, spiritual, and practical support to the death, dying, and transition experiences.
3. Invest in peer support programs and mental health resources. Train staff in trauma-informed care peer support models. Socialize and ensure access to mental health care that understands occupational grief and moral injury. Remove barriers to care, including cost, stigma, and time constraints. Go beyond the Employee Assistance Program, and incorporate systems offering real-time response and support.
4. Address the root causes of moral injury. When staff are forced to choose between their values and their job requirements due to inadequate resources or harmful policies, that's a leadership failure. Advocate for adequate staffing, resources, and policies that align with the mission of care. Listen to frontline workers who see the gaps and are harmed by them, and work with them on systems improvements.
5. Model vulnerability and honesty from leadership. When leaders acknowledge their own grief and struggles with the weight of these times, it gives permission for others to do the same. Transparency about institutional challenges, combined with genuine efforts to address them, builds trust and shared purpose.If you're an organizational leader committed to being a good steward of people while achieving organizational goals and business impact, the CARE Framework offers a roadmap to get there.
Grief Becoming a Window
Andrea Gibson writes about grief becoming a window—a moment when pain allows us to see what we couldn't see before. Perhaps that's the transformational work ahead for all of us in healthcare: to let our collective grief become a window into what needs to change.
We can see now, with clarity born from loss, that individual resilience isn't enough. We can see that the systems we work within are not inevitable—they are design choices, made by people, and they can be remade through redesign, rewritten policy, and committed practice. We can see each other's humanity more clearly, the weight we all carry, the courage it takes to show up when showing up means confronting and anticipating loss again and again.
The grief is real for our healthcare professionals. It's an echo, as Gibson says—of all the losses before, of all the times care was denied, of all the times illness and death could have been prevented, of all the ways we've been asked to sacrifice ourselves and those we serve at the altar of productivity and profit.
But if we listen closely, if we create space for reflection, if we build rituals that honor what's been lost, if we hold each other up in relationship—the echo might become something else. The echo becomes a collective acknowledgment that the professional grief is real, it isn't just ours to hold, and neither is the work of healing.
We owe ourselves, each other, and every person who will need our care tomorrow and in every season to come, a commitment to tending together.
I’m Andi Phillips, a licensed clinical social worker with nearly two decades of experience across education, community, and health care settings. Today, I am helping organizations and leaders transform workplace cultures to create desired futures rooted in care, creativity, and connection. Outside of organization and leadership consulting, I provide therapeutic services to support professionals struggling with burnout, mental health, and work-life balance. You can learn more about my work at Desired Futures Counseling & Consulting.
For any inquiries, please contact:
Andi M. Phillips, LCSW
Email: andi@desiredfuturescounselingandconsulting.com
