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Systemic trauma and systemic turnover: is there a correlation to the healthcare turnover crisis?

This is part three to the “The high cost of complacence: addressing systemic turnover in healthcare.” series.  

According to research by Brunk (2015) and Paolini (2009), physicians experience higher rates of stress, suicide, and addiction than any others.  Consider Paolini’s (2009) description of medical school,

Every moment of medical school is said to be a grueling practice of day- after-

day coping; introducing the psychological phenomenon of splitting as a

means of explaining medical school survival. Splitting, described as ‘difficulty with the

ability to hold opposing thoughts, feelings, or beliefs about oneself or others’ (p. 20),

becomes the means by which medical students disassociate themselves with the day-to-day rigor in order to survive. Thus, students are directly entrenched into a complex and

dynamic environment that erodes individual routines and relationships (Lord &

Schecter, 2016).


Further, when we consider the amount of time that medical-students and student-residents are exposed to role-models, it is tantamount to the social-mentoring construct as part of the socialization process (Lord, 2007),

Socialization is an organizational and/or professional process that ensures conformity

through practices that deeply embed the professional values, norms, and practices.

Negative reinforcement socialization behaviors (i.e., berating, yelling, unsupportive) are

well known within healthcare, producing further stress, burnout, and turnover among

both veteran and novice clinicians. 


Nursing is not immune from its own source of trauma.  It’s been widely reported and documented, that many veteran nurses will not help novice nurses once they enter practice.  There's a reason why the mantra “nurses eat their young” remains sage advice to novices.  The lack of socialization among nurses has been proven to be a significant indicator of a career casualty among nurses.  Among the sample, nurses who indicated a lack of socialization did not remain in the career past five years (Lord, 2007).


Research into the temperament profiles, be it MBTI, Personalysis, DiSC to name a few, all have associated negative behaviors that result when we’re stressed.  If we consider that its possible  everyone in healthcare is working from a state of stress its likely to result in a highly, negatively charged environment in which everyone is suffering.  Thus, we continue to perpetuate the cycle of trauma by virtue of yelling, berating, and gas-lighting our peers and colleagues. 


Knowing that this degree of stress exists within the two-primary or at least oldest healthcare professions (nurses and physicians), should we expect anything different in healthcare organizations?  Is it the lived trauma of medical school, nursing school, ED scribes, and poor role-modeling that has resulted in a Stockholm syndrome permeating healthcare culture, maintaining the constant ebb and flow of high turnover?  


In discussing ways to reduce stress and trauma with fellow coach and friend Michon G. of Rooted2rise coaching (, I shared with her the impossibility of a nurse, an ED tech, a physician, or anyone else in healthcare to simply walk away when they’ve reached the moment of dis-stress…yet again.  So how do we care for each other? How do we in healthcare take back control of our current reality to find real solutions?  How do we break out of this pattern of frustration, stress, and apathy when someone might literally have their finger in an aortic-dike?  


Knowing that we are all suffering together simply isn’t the answer.  We can however commit to beginning with one small step, a step of kindness.  How will you begin?

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