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ER Nurse pioneers ‘the Pause’

ER Nurse pioneers ‘the Pause’

Jonathan Bartels, an ER nurse at University of Virginia Medical Center often encounters death.  But being continually face-to-face, he found it wearing him down.  His story was recently featured on the website of NPR station WMRA.

Each time we would resuscitate someone and attempt to resuscitate them, you know at times we couldn’t save them. And it started to wear at me on times and I started to notice staff responses to that. And staff responses were often frustration, disappointment, a feeling of failure, you could see pain in the physician’s eyes, you could see pain in the nursing staff.

In order to cope, he said, most medical professionals stop thinking of the person in the bed as person, but rather just a body that they are trying to resuscitate. Disconnection, he acknowledges, is necessary on some level. But it can also be harmful and lead to burnout – a state he said he has experienced on more than one occasion.

The ER is a busy place though, so often as soon as the patient was declared dead the staff would hurry off to tend to the next case.  But that all began to change a couple of years ago when during one such case, the chaplain came in and asked everyone to stay for just a moment.

The prayer portion was hard for him because he said he, like many others at the hospital, comes from a different religious tradition than the chaplain. But he kept thinking about her action.

Shortly afterwards, Bartels himself asked the team to take a moment, a short pause, when a patient died to recognize the humanity of the deceased person.  Soon, other nurses began doing the same and the practice began to spread throughout the hospital.

Bartels has published a paper on the Pause, as its called in the journal Critical Care Nursing, and the practice is now beginning to spread to other hospitals.

The pause slows our racing minds, offering mental space so that we are not drawn into the vortex of failure versus success. We bear witness to a reality devoid of projections. We give ourselves the opportunity to forgive—and be forgiven. This practice removes the impotence that colors loss in health care. It empowers each individual to offer support without imposing beliefs on others. It is both communal and individual, and it allows for secular, religious, and humanistic perspectives. It is simplicity infused with complexity. We are called to bear witness to the reality of loss and the acceptance of reality.


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Judy covarrubias

Lovely story. The idea is wonderful. So respectful.
Thank you.

Rod Gillis

Very engaging. I sent the link for the original NPR feature to the several nurses in my family. One responded fairly quickly with this comment, “We really could have used this in the ER . Great idea !!!”

JC Fisher

NPR also recently ran a follow-up story, on a med student beginning Gross Anatomy 10 years ago (who’s a doctor now). The attitude they brought to their cadavers—to take that moment of gratitude, and remember their humanity (before beginning the dissection necessary to their training)—has stayed w/ her in her practice. It was a truly encouraging story.

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