Practitioner-Led Peer Support

EW: Introduce yourselves and share more about the missions of Don’t Clock Out and Introspective Spaces.

We’re Laura Holford, RN, and Anu Gorukanti, MD, co-founders of Introspective Spaces, a social enterprise committed to creating reflective spaces for healthcare workers. Joining us is Sarah Warren, RN, co-founder of Don’t Clock Out, a mental health nonprofit dedicated to supporting healthcare workers through the effects of moral distress.

At Introspective Spaces, we believe patient well-being is inextricably intertwined with clinician well-being. Our mission is to cultivate spaces where healthcare workers can reflect, connect, and heal through contemplative and creative practices rooted in our diverse traditions.

We recognize the connection between the systemic challenges healthcare workers face, from racism to profit-driven care models, and the moral distress they inevitably experience. We seek to disrupt the isolation healthcare workers often feel and offer tools for personal and systemic transformation within community spaces that reach across the medical hierarchy.

While we wait and work toward a more just healthcare system, we aim to reclaim our agency by caring for one another in contemplative community.

Don’t Clock Out is a peer-led mental health nonprofit built by healthcare workers for healthcare workers. DCO provides essential peer support, acknowledging the critical need for spaces where healthcare professionals can connect with others who understand the weight of moral distress. By cultivating community and solidarity, we address the systemic exploitation that leads to burnout and moral injury.

DCO’s mission is grounded in the belief that healing in healthcare requires acknowledging these realities and creating networks of care where healthcare workers feel seen, supported, and understood.

Both DCO and Introspective Spaces share a vision of nurturing healthcare workers in ways that allow them to show up as the best versions of themselves, advocate for justice, and transform the care we provide.

EW: What inspired you to start your organizations?

Laura, Introspective Spaces: Introspective Spaces was born from a deeply personal journey that Anu and I each experienced in our healthcare careers.

For me, it was an extension of my Christian faith and a desire to live out teachings of compassion, like those found in the Book of James: to “care for the widows and orphans.” Nursing was my answer to a longing to serve vulnerable populations.

Becoming a nurse seemed like the perfect way to continue that mission, but when I entered the field, I was shocked by the cynicism and burnout I encountered among my colleagues. The breakneck pace left no time for reflection. I experienced my own moral distress and spiritual injury, feeling helpless and overwhelmed by the systemic problems within healthcare.

I began experiencing panic attacks for the first time, and eventually my physical health deteriorated as well.

Anu, Introspective Spaces: For me, Introspective Spaces was born from a deep desire to build community for healthcare workers.

Throughout my medical training, I struggled with feelings of isolation and disillusionment with the medical system and the systemic inequities affecting patients. It wasn’t until years later that I discovered what I was experiencing was moral distress, and that I wasn’t the only one who felt that way.

My friendship with Laura served as a lifeline for both of us. Although we came from very different cultural and faith traditions, I could speak openly about how my Buddhist faith and values often felt at odds with the injustices I witnessed in the hospital.

I realized that having spaces where I could share all parts of my identity, mourn patients who had died, and process the emotional and spiritual effects of the work was essential if I wanted to remain in healthcare.

As we navigated our careers, we longed for spiritual and reflective spaces where healthcare workers could process their experiences and reconnect with the meaning behind their work.

We created Introspective Spaces to fill this void and foster a community where healthcare workers can bring their whole selves, including the many identities they carry, into the conversation. Those identities can become untapped wells of strength and resilience.

We believe addressing moral distress requires more than self-care. It requires community care, with spaces where we can witness one another’s stories and offer mutual support. Through retreats, workshops, and shared contemplative practices, we aim to help healthcare workers reconnect with their values, find healing, and reimagine a more just and compassionate healthcare system.

Sarah, Don’t Clock Out: When I graduated from nursing school, I experienced a traumatic event that led me to therapy for the first time. I was the first person in my family to speak openly about my mental health and seek help.

I wasn’t in crisis, but I knew I didn’t have the tools I needed to cope with what I had experienced. Seeking help allowed me to recognize when I was struggling throughout my career as a bedside nurse.

In December 2021, I suffered a spinal cord injury that took me out of my role as a bedside nurse. In spring 2022, a nurse in the Bay Area left their shift and didn’t come back. This rocked the nursing community and led to the creation of Don’t Clock Out.

I realized that something healthcare workers were missing was peer support led by other healthcare workers. In fall 2022, I began facilitating weekly peer-support groups for nurses. Eventually, our team grew into an interdisciplinary group of healthcare workers, and we have continued hosting these groups ever since.

When I was at my lowest as a bedside nurse, I needed to know I wasn’t alone. I needed to know I wasn’t the only person struggling with institutional betrayal and the injustices affecting my patients and colleagues.

Through peer support outside the systems that intentionally and unintentionally cause harm, we have created a safety net for healthcare workers who have felt isolated and abandoned.

As our work expands, I hope we can become a catalyst for a healthcare culture that nurtures and supports the people who care for others instead of exploiting their empathy.

EW: You’ve likely encountered many powerful stories about the consequences of not addressing burnout, mental health, or preparing for the end of life. Could you share one that has particularly affected you?

Laura: As a new graduate oncology nurse, I experienced a crescendo of moral distress as I watched patients endure unnecessary suffering.

I regularly cared for terminally ill patients who had expressed a desire to stop treatment and find peace. But for many reasons, including a lack of conversations, family wishes, fear of death, and a diffusion of responsibility, I was tasked with carrying out orders that I knew were only causing more pain.

These patients’ suffering weighed heavily on me. I felt like I was contributing to their pain and prolonging their lives against their wishes, not because it was in their best interest, but because the healthcare system wasn’t equipped to provide the time, space, or skills necessary for difficult conversations.

No one took ownership of discussing the reality of the patient’s situation. As a nurse, I was unprepared for this kind of suffering, which felt preventable and deeply misaligned with the compassionate care I wanted to provide.

Brené Brown’s definition of spirituality resonates with me here: “Spirituality is recognizing and celebrating that we are all inextricably connected to each other by a power greater than all of us.”

I believe the well-being of patients and providers is interconnected. When I contributed to unnecessary suffering, I suffered too.

The moral distress I experienced led to physical and emotional breakdowns, daily panic attacks, and debilitating pain. For the first time, I could understand, without judgment, why people living with pain might decide to take their own lives.

As nurses, we sign up to accompany suffering and care for patients as they face disease and death. But the unnecessary suffering caused by systemic problems, including inadequate staffing, limited time, and a focus on profits over people, was something I wasn’t prepared for.

It became clear to me that moral distress, the emotional turmoil caused by knowing what is right but being unable to act on it, wasn’t simply a personal struggle. It was a structural problem within healthcare.

This experience, along with many others, ultimately connected me with the mission of End Well. I believe that when the end-of-life experience aligns with a person’s values and goals, it honors the patient while alleviating immense emotional burdens for healthcare workers.

End Well’s vision to transform how the world thinks about caregiving, grief, illness, and the end of life resonates deeply with me. By fostering a future where ending well is understood as a measure of living well, we can radically reduce the moral distress faced by frontline workers, families, and caregivers.

When we make room for meaningful, compassionate conversations about mortality, we address one of the most profound sources of burnout and suffering in healthcare.

EW: What societal norms or beliefs about mental health, healthcare, and the end of life need to be challenged or redefined?

Anu: Healthcare continues to deeply stigmatize mental health and grief.

Although we care for people during the most vulnerable moments of their lives, we rarely have the opportunity or capacity to hold space for the complicated emotions that arise for patients or for the colleagues witnessing these experiences every day.

During my medical training, when a patient died during our shift, we continued working and caring for other patients without stopping. While we absolutely needed to continue caring for others, I struggled with the complete absence of space to grieve and mourn.

Healthcare needs spaces where workers can be vulnerable with one another and process their experiences in community.

Organizations such as Don’t Clock Out provide an essential resource, allowing healthcare workers to discuss their mental health, moral distress, and grief in a nonjudgmental community space. Spaces such as End Well are also vital for normalizing the physical, emotional, social, spiritual, and mental effects of grief.

At our Introspective Spaces retreats, grief and mental health emerge organically as major themes. We use art, contemplative practices, and reflection to help participants bring these experiences to light.

By engaging in conversation within community, we can tend to our mental and physical well-being and feel less alone. We are grateful to work alongside organizations at the forefront of changing healthcare culture.

EW: This year at End Well, you’ll be offering a peer-led drop-in space called Feelings Space. What can attendees expect?

Laura: Just as End Well’s mission emphasizes that all people should experience the end of life in a way that aligns with their values and goals, we believe the experience of the event itself should reflect participants’ values and needs.

Feelings Space is designed to honor participants’ sensory, somatic, and emotional needs as they engage with profound topics related to mortality.

We hope this drop-in sanctuary offers an opportunity to move from the rich insights of cerebral work into an embodied experience of the feelings that may arise throughout the day.

Whether attendees wish to engage in narrative writing, movement, poetry, meditation, or collage, Feelings Space will provide opportunities to pause and process in a meaningful way. Rituals and expressive art will also be available for those who wish to honor loved ones who have died.

Attendees can come and go as needed, maintaining their connection with the conference while stepping into a space for reflection, creativity, or solitude.

Sarah: Over the last two years of facilitating weekly peer support for healthcare workers, I have witnessed the power of giving people permission to share how they feel.

When we do so with a group of peers, we begin to honor our shared humanity and recognize that we are not alone.

The themes explored at End Well can bring forth complex emotions. Having an open and welcoming container in which to share and receive support may encourage people to take steps toward their own long-term healing.

EW: What was the most surprising or memorable part of last year’s End Well event?

Anu: Last year was my first time attending End Well. Before attending, I didn’t know much about the organization beyond its mission to support caregivers, clinicians, and patients navigating grief and loss.

I was blown away by the beauty, depth, and vulnerability of the event. Listening to such a diverse range of stories helped me unlock feelings of repressed grief from my years of medical training.

It felt wonderful to be in a space with so many kindred spirits who were open to having difficult and necessary conversations about what it means to live and die well.

I loved everyone I met that day, and I’m excited to attend again this year.

Sarah: Last year was also my first time attending End Well, and I was given the opportunity to bring a group of friends with me.

Our group included approximately 12 interdisciplinary healthcare workers, patients, and caregivers who experienced End Well together. The event brought us closer as we opened ourselves to the idea that we can and should talk about the end of life, and that our grief is something we must pay attention to.

I feel emotional knowing that this year we will experience End Well through a new lens, holding space for people who care for others.

By offering peer support for the complex emotions that may arise, we begin the long-term process of identifying what we feel and what we can do to support ourselves and one another.

EW: Do you have any upcoming projects or offerings the End Well community should know about?

Introspective Spaces and Don’t Clock Out are excited to announce an upcoming webinar series through our newly launched partnership, the Reimagine Healthcare Collective. The series will focus on addressing moral distress in healthcare.

This initiative is designed for healthcare professionals who want to explore the emotional and ethical challenges they face in their work. It will provide tools and strategies for navigating moral distress while prioritizing personal and collective well-being.

Our mission is to create community education for healthcare workers, by healthcare workers, rooted in a radical reimagining of what caring can be.

We believe shared wisdom and collective action are foundational to building a more just, equitable, and abundant healthcare system. By coming together, we can work toward a future where patients and providers are supported and care is rooted in compassion, justice, and a commitment to well-being for all.

Learn more and register for the Reimagine Healthcare Collective’s moral distress webinar series.