In the final week of March, a month many of us will remember as the longest of our lives, I called Tara Rynders, a dancer and Registered Nurse who lives and works in Denver, Colorado. Tara was in the final stages of her 2019 Fellowship for Socially Engaged Art, during which she had expanded her immersive dance, First, Do No Harm, including a future performance that was to be presented by A Blade of Grass at a New York City hospital this year. With that performance on indefinite hold while the city expends the full force of its hospitals and medical personnel to survive COVID-19, I was curious to hear Tara’s perspective, as a frontline healthcare provider herself, and how the framework of empathetic connection and unbiased care taught through her workshops was helping her prepare for this new reality. Tara made clear that this is no time to lose our humanity, that it will be, in fact, required to rise to the occasion. Also, while we know what healthcare workers need now in the form of recognition and material support, this experience will wreak fall-out for them emotionally and psychologically that we will also need to be prepared to provide.
Since we spoke, Tara has developed and been appointed to a full-time position of Nurse Specialist: Resiliency, Innovation, and Outcomes. The position is unique to the Rose Medical Center, where Tara works, and will include implementing theraputic programs and advocacy for the specific mental health challenges of healthcare workers based upon the strategies she’s honed through her The Clinic workshops. The hospital-wide incorporation of these practices will provide a significant case study, during and after this current health crisis, on how addressing the psychological and emotional needs of healthcare workers might relieve their trauma and grief and translate to better patient care and outcomes. Rynders has also created a virtual version of the resiliency workshops for nurses that will be offered during the Reimagine End of Life Festival this June. The flowing interview has been edited and condensed.
Kathryn McKinney: Thanks for taking some of your precious time off to speak with me. Can you tell me what your schedule has been like?
Tara Rynders: I work 2-3 days a week, and I’ve been working in the infusion center, which is an outpatient setting in the hospital setting. They pulled me off of that last week, and I’ve been doing resiliency and wellness work with our nurses and rounding all the different departments of the hospital to check-in, give them a chance to speak and talk about what’s going on emotionally, see how they’re feeling, and doing meditation with them. Just trying to increase the presence of wellness within each department so that they don’t burn out.
KM: Can you tell me a little bit about how you pursued both career paths as a nurse and a dancer. Did you always see a natural correlation between both types of labor?
TR: I’d grown up dancing my whole life. Looking back I think it was always what I used to help my own personal resiliency. In college, I studied dance alongside nursing. It was something I refused to let go, for my own personal well-being and wellness I needed to move my body that way. I was working as a nurse for a couple years when my mom was diagnosed with cancer, so I took care of her all through her hospice. After she passed, I realized I needed to take some time to focus more on myself and grieve. I went back to school and got my Master’s in dance at the University of Colorado at Boulder. From there, I’ve always had this intertwining of movement and nursing [but] I didn’t necessarily realize there was a natural correlation between the two until I did my thesis.
When I was just about to finish my Master’s degree, my sister got really sick. She was in a coma for a couple months, and I ended up taking a break from my MFA and moved into the hospital with her. When she was in the hospital, I spent every day with her. It was then that I really made the correlation between dancing and nursing. So much of it is in this line of intimacy that I learned from caring for her and that I felt really called to present in my work as a performer. I used to turn on, her favorite song was “Party in the USA” by Hannah Montana [sic]. I would just dance around the room, and it would make her laugh; even though she couldn’t speak, she could still laugh. When I had to go back to school and do my thesis, I didn’t know how I could do a performance, it all seemed so trivial during this time of a lot of grief, so I created a project called You & Me. The audience came to my home. They received appointment cards, almost like a triage center. They had one on one appointments, it was all very interactive, and based on experiences I had had with my sister. Since then, my work has evolved into The Clinic, which includes a workshop series for nurses and an immersive theater performance that takes place in the hospital setting called, First, Do No Harm. My personal experience as a patient in the hospital, coupled with my experience as a nurse and a family member caring for my mother and sister are why The Clinic exists.
I wanted them to see from an outside perspective, looking at themselves through performance, what they’re going through.
KM: Certainly, your experience from both sides of giving and receiving healthcare explains part of the impulse to combine the two. Could you tell me a little more about The Clinic workshops and First, Do No Harm? How did this project originate, and what exactly were you looking to address?
TR: So, there was another experience. I had an ectopic pregnancy. I started having excruciating pain, so I drove to the hospital. It got really bad, really quick. I was put in this room, and I remember just passing out and trying to call my nurse because I was bleeding internally. They called a code yellow, which is the code you call before code blue, and so all of the nurses and doctors and therapists and lab technicians and pharmacists all come to the code. I was passed out, and I couldn’t speak. I remember them yelling, and handling blood, my feet are up in the air to help preserve the blood flow. This was the first time I was actually the patient, and I was acutely aware of this experience of being passed out and still being able to hear what was happening. In the midst of all that crazy chaos, a nurse took my hand and said, “I’m here. You’re going to be ok. I’m here with you during this.” I just remember thanking her, I was really scared.
That was a really traumatic experience, and when it was over, I felt like I had to share with nurses what it felt like to be a patient. Having been in a really privileged place to know this, and also having family members [as patients], I felt like I was given all this information that could really help us as caregivers do a better job in terms of communication. That nurse in that moment, I felt like she really saw me as a person. She saw my pain and my suffering, but also really knew how to connect with me. I wanted every patient to have that experience. I realized how bad I was doing in the past, thinking I was connecting, but really just directing patients.
I began researching and found that bottom line, our nurses are tired, fatigued, and although very skilled, they don’t have the time and space to utilize those skills or resources. I wanted to have people become more aware of what compassion fatigue and burnout was. Not only the general public, but also nurses and physicians, and other healthcare workers because there’s still a stigma around mental wellness in general. I wanted them to see from an outside perspective, looking at themselves through performance, what they’re going through.
I also really wanted to highlight the nursing perspective, the perspective that’s often marginalized. You don’t hear much from nurses. That’s what led me to the performance [First, Do No Harm]. It was open to the public, so the public came into the hospital, and we took them to all these really cool places that nobody ever goes [sic]. We added more shows, received a lot of awards and recognition, but the biggest for me was that the nurses and physicians, and other healthcare providers who know me thanked me for telling their story, saying they felt so seen and they felt often overlooked. That was a big realization that this was really important work.
Then the workshops [The Clinic] came next. They were based on the See Me As A Person framework and based in play. So a lot of it was talking about really important issues, but using play as a way to address them. Then allowing time to look back and process all together, nurses, artists, and physicians talking and creatively thinking and collaborating on these issues.
KM: Can you tell me what you were observing with nurses on this issue of compassion fatigue when you were running these workshops, and what they were telling you about the stigma, how it impacts their ability to do their job, or how they feel about themselves?
TR: I think the biggest thing was giving them the space and time to even be able to think about it. I think they know they’re tired, and they know they’re burned out. But by the time you get too burned out, you’re already looking for a new profession. We’ve lost a lot in this profession for that reason. Now, after looking back on the workshops, I think a lot of it comes down to our grief. That nurses are grieving really heavily all of the time. They’re experiencing a lot of loss for their own self as well as their patients.
The thing with compassion fatigue and burnout, you’re taught in school, “this is how to take care of your patient.” People who go into nursing are nurturing, caring people who want to make a difference in people’s lives. The hospital setting is really set up [for nurses] to fail; we’re not really capable of caring for patients in the way that they need to be cared for because we’re so busy because the hospital is a business. There’s a margin, they’re trying to see how many patients a nurse can safely take, but that doesn’t always allow for connected, authentic care and you cannot really follow a formula when caring for people with real needs. And that’s just one part of it, but it’s the reality that we’re running alongside a business.
Nurses, at times, feel like their best, at the end of the day, isn’t good enough. We’re never able to give the patients the resources they need because we probably don’t have them. We’re never really able to sit and talk with that elderly patient that just really wants to share their story. We’re just trying to get out of that room as fast as we possibly can because our other patient in the other room is in intense pain, and they’re due for pain meds, and they’re going to be wailing in a minute. It’s just never good enough. That weighs on you emotionally everyday. That’s what I think is a big component with compassion fatigue, along with our grief. Nobody is addressing our grief and caring for nurses.
KM: You use the See Me As A Person Framework at The Clinic, a framework that, by my understanding, was developed for hospice and palliative care (treating patients with terminal illnesses). As the amount of populations around the world become infected with COVID-19 rises daily, as do the number of deaths, is it possible that the general public might absorb this framework into their own communities, families, and personal perspectives now? Certainly, our legislators could, as they debate the lives and livelihoods of millions and the functioning of hospitals right now…
TR: Yeah, absolutely. See Me As A Person framework [was] developed by the Creative Healthcare Network, partnered with the Daisy Foundation, a foundation created to look at extraordinary nurses and what they’re doing differently. They came together and used See Me As A Person framework to create a new language for nurses. A lot of nurses think, as a profession, we’re not able to speak about what it is that we do. It’s a lot of “I’m a nurturer,” you know they call us “their angel.” That really separates our humanity and separates what it takes to be able to take care of someone at an “angel” level.
So this framework gives us a language to be able to talk about what it is that we do. If you don’t have a language, you can’t teach it, so it’s either you got it or you don’t, and in that case, we’re just setting up other nurses to fail. Part of the thing we added to this was an empathy framework, getting curious about the situation, asking a lot of questions, trying to understand from that person’s experience, and immersing yourself in that, connecting, and then being able to detach and make knowledgeable decisions about what should be done. You don’t see anybody coming to hospitals right now trying to understand the situation better. We’re just all kind of fending for ourselves right now. Like you said, policymakers are making decisions without even really bringing frontline workers to the conversation.
KM: This might have been addressed by the way your work has been rerouted at your hospital, but I’m curious if hospitals are simply too overstretched to be able to incorporate this framework and sense of personal connection into their care now? Does this necessarily become less of a priority as the baseline needs of nurses, things like a lack of PPE and medical devices like ventilators, and an overwhelming influx of patients becomes the new reality? Do you see how these could exist in parallel?
TR: I think it’s a little bit of both. Unfortunately, New York has been hit, and they’re probably in survival [sic]. They don’t have time to think about these issues of wellness and resiliency for their staff. Hopefully, these hospitals already had something in place caring for their nurses, but overall most hospitals don’t. Education and self care is in some ways a privilege. Just as we’re seeing in everything that’s been canceled, even education, you realize it’s a privilege when your health needs are not being taken care of first. Those things have to be taken care of, so when you’re in that place of emergency care, these things do fall to the wayside.
Colorado is definitely up there in COVID cases; I do think it’s due to the work that we’ve been doing through The Clinic and First, Do No Harm that my hospital has asked me to take on some of these different roles around resilience and wellness for our nurses. When you look at the situation of what my hospital is doing, I think you realize how important it is, making wellness a priority for nurses, knowing that two weeks down the road we might be where New York is. [We’re] starting an in-house pantry for healthcare workers who might need things they can’t afford, just creating a community for our hospital to care for one another. I don’t know if other hospitals have those resources.
Editor’s note: The healthcare workers’ pantry can accept donations via an Amazon wish list Tara has set up with the food and hygiene items most needed.
You don’t hear much from nurses.
KM: We’re discussing treating this disease in terms of being “at war,” which we know inevitably leads to those at the front lines becoming traumatized. Are there practices those treating patients can do to help themselves cope right now? What role do creativity and artistry play when you’re having to face these insurmountable challenges and grief daily?
TR: I think there’s a lot that can be done in the midst of it. For each person, it’s going to be different in what they need. I usually try to bring like a platter of different ideas and tools that nurses can choose from. The biggest thing when we’re in it, which we are right now and I think it’s only going to get worse in the next couple of weeks, is to make sure that we’re listening. Asking them what they’re feeling. What are their fears? Allowing them to just feel heard.
That’s a big part of See Me As A Person, just meeting them where they’re at. Not necessarily having any answers, but connecting with them, empathetically hearing them speak. I have people do a lot of writing. Just five minutes to write down whatever it is they’re feeling, it doesn’t matter, just that they’re writing and coming together to share some thoughts. Mindfulness meditation, taking a lot of deep breaths together, and then after that thanking them for what they do, and having them thank themselves, get in touch with their emotions, where they’re at with their fears. Allowing it to come up. Their fears are keeping them alive, because that’s what fear does, but helping them realize they can’t just stay in that place of fear forever. They have to use their whole brain to problem solve.
KM: This is a paradigm-shifting scenario that will undoubtedly lead to major changes in healthcare, our government, the arts, and how communities function. We don’t know if those changes will be for the better or not yet. What role can nurses, and artists, play in pushing forward an agenda of equality, compassion, and dignity for all human beings?
I think a big part of it is recognizing our biases as healthcare providers. Doing a lot of thought and training on our privilege and bias. The more I do the work, the more I realize how intertwined it all is. White supremacy, as a baseline, is how the healthcare system was even set up. In general, there’s a lot to be shared and to be learned.
And I also think grief counselors are going to be really important. I didn’t realize how much grief nurses hold, so being able to help them with their grief is going to be even more important now after all the death they’re experiencing. At the end of the day, it’s loss; we’re all losing something, whether it’s our job or social experiences, whatever it may be.
KM: I know that this idea of disparity and implicit bias is central to the work you’re doing with the clinic. Is there any more you’d like to say about that?
TR: We’re very far behind on recognizing the need to check and look at our biases. I think that is very tied to nursing burnout. What we learn through the work that we do is that we’re all being hurt by these biases and these privileges. It’s not benefiting anybody at the end of the day. Obviously, those that are white aren’t recognizing that because of the privilege that they do receive, but it’s not benefiting anybody because we’re all connected, and it’s bringing everybody down. I’m still figuring out how to connect these two worlds, and how to present it in ways that hospitals will be able to receive it and educate their staff. I think the east coast and west coast have begun to do this work, and I’m partnering with some people to help me because it’s tricky.
KM: I’d like to hear anything else you want to say or speak about.
TR: I want to thank Jadd Tank, Lia Bonfilio, and Clare Hammoor, who have co-directed our performances and workshops. Bringing together artists and nurses has been a really inspiring experience for both the artists and the nurses, and I am forever grateful for the guidance and care from our co-directors.
I think it’s really hard to be in the midst of the struggle and still be a forward thinker, while at the same time feeling very buried myself. I am feeling very overwhelmed personally with the task at hand, and yet the desire to want to think bigger and better and what you can do to help. It’s just very frustrating to know who to trust in this. I want to believe that everybody is doing the best that they can to get what’s needed to the front lines, but I’m having a hard time trusting that. I feel a little bit frozen in this work, and it’s been my passion for so long. I’ve always been a dreamer, but it’s hard to be a dreamer right now, and I think that’s really sad.
Part of that empathy framework is to detach from everybody so that I can think, “Ok how can we think clearly, what can we do, how can we prepare for when get hit like New York is getting hit, or even after that when things start to settle, and we have all these care workers, who their baseline is burn out, now what are they?” We need a new term because that’s not going to cut it.