Holding the Holders: Rethinking Self-Care in Hospice Work

Hospice work asks us to hold far more than is ever written in a job description. It asks us to be present at some of the most tender and difficult moments of human life. It involves not only clinical skill, but emotional availability — the ability to sit with uncertainty, to witness suffering, and to remain open in the presence of grief, fear, love, and loss.

Much of this work is unseen.

It lives in the pauses, the silences, the moments of listening without fixing. It shows up in the way staff steady themselves before entering a room, or in how they carry one family’s story while moving gently into the care of the next.

Over time, this holding gathers — not with force, but with constancy — like water shaping stone through repetition rather than impact.

You like me, work in a hospice, and those who work in hospice settings are deeply aware of the privilege of this work, and of its meaning. Yet meaning alone does not protect the nervous system, the body, or the heart.

The impact of sustained emotional exposure is real, even when the work is chosen, loved, and approached with dedication.

In recent years, there has been growing recognition of the need to support hospice staff wellbeing. However, many approaches to “self-care” still sit at the surface, offering moments of relief without fully acknowledging the depth of what hospice professionals are asked to hold each day.

To care sustainably, we need forms of support that are as thoughtful, embodied, and realistic as the work itself.

Why traditional self-care often falls short

In many healthcare settings, self-care is framed as something added on: a wellbeing day, a relaxation session, a reminder to “be more resilient.” While these initiatives are often well intentioned, they can feel disconnected from the lived reality of hospice work.

Hospice professionals are not simply tired or stressed. They are repeatedly exposed to loss, to anticipatory grief, to emotional complexity that does not resolve neatly. We are walking daily alongside suffering and death.

We are talking about secondary (indirect or vicarious) trauma, that we experience as a result of working with or being with traumatized people.

This is not a matter of burnout alone, but of cumulative exposure — the gradual layering of experiences that the body and nervous system continue to carry, even when the mind understands the purpose and value of the work.

When self-care is presented primarily as an individual responsibility, it can unintentionally suggest that staff are not coping well enough, rather than acknowledging the inherent weight of the role.

Practices that focus solely on relaxation or positivity may offer temporary relief, but they do little to address the deeper imprint left by sustained emotional holding.

A trauma-informed perspective invites a different understanding.

It recognises that repeated exposure to distress — even in compassionate, supportive roles — shapes how the nervous system responds over time. It shifts the question from “How do we help staff cope better?” to “How do we create conditions that allow people to work with grief and loss without becoming depleted?”

Rethinking self-care in hospice settings does not mean abandoning existing wellbeing initiatives.

Rather, it calls for a broader, more compassionate approach — one that honours the depth of the work, normalises its impact, and supports staff in ways that are woven into daily practice, rather than added as another task to complete.

Holding ourselves in practice: learning from Micropause at St Raphael’s

We are at risk of developing emotional burnout and compassion fatigue if we don’t create regular space to be able to process and release what we carry.

Aware of this situation some hospices hold monthly reflective practice groups, where staff share emotional experiences in a safe, held space. Others have softly lit “transition rooms” where staff can pause before or after shifts and benefit from herbal teas and grounding music.

I don’t have all the answers but let me share our experience. At St Raphael’s Hospice, -the hospice for the boroughs of Merton and Sutton in London- our approach to staff wellbeing has grown out of experience rather than theory.

It emerged from listening closely to what colleagues were actually carrying, and from recognising that many did not need more instruction, but more permission — permission to pause, to soften, and to come back into themselves, even briefly, within the working day.

This led to the development of a “scent pause” ritual: a simple, trauma-informed programme offering short, embodied moments of rest and regulation for staff and families.

These pauses are not framed as treatment, performance, or productivity tools. They are intentionally modest — a few minutes of stillness, guided attention, breath, gentle sensory grounding through aromatherapy — designed to meet people where they are, rather than asking them to change their state.

The ritual includes a rotating selection of aromatherapy blends that staff can use before coming to the ward, after or in a moment of pause between patients. It’s voluntary and simple. It also includes a selection of questions aimed to spark reflection, grounding and a sense of wellbeing.

What has been striking is how effective these small moments can be. In a setting where time is scarce and emotional demand is high, scent pause does not ask people to step away from their work for long periods.

Instead, it acknowledges that even brief, intentional pauses can help the nervous system settle, allowing staff to move from one encounter to the next with greater presence and less internal residue.

For staff, this initiative has become a way of marking transitions — between patients, between roles, between intensity and rest. It offers a shared language within teams: a quiet understanding that what they are carrying matters, and that tending to it is part of the work, not an indulgence outside it.

For families, these same principles create moments of containment and calm within an otherwise overwhelming landscape.

Gentle sensory grounding and guided pauses can help families settle into their bodies, even briefly, creating space for breath, connection, and emotional processing without pressure to speak or resolve anything.

What this initiative continues to teach us is that sustainable self-care in hospice settings does not need to be elaborate.

It needs to be relational, realistic, and responsive. When care for staff is woven into the fabric of daily practice, rather than added as an extra task, it becomes something people can actually receive.

I would warmly welcome conversations with colleagues across the world who are exploring ways to better support those who give so much of themselves. If you are developing, questioning, or simply reflecting on how we hold the holders in your setting, I would be glad to connect, learn together, and continue this important dialogue.

Author: Ana Angarita