Title : RISE: Caring for the human behind the credentials
Abstract:
Background: Healthcare professionals operate in environments where secondary trauma, moral distress, and cumulative stress are persistent and often interwoven experiences that compromise clinical practice, affect ethical community, and professional well-being. Children’s Health Dallas identified a need to enhance the institutional climate by creating a moral distress consultation service called RISE in 2015 to provide structured, confidential support and to strengthen the system community. While providing moral distress support, a gap was identified in the care provided to team members experiencing burnout/ depletion and the second victim phenomenon, so in 2019, RISE (Resilience, Integrated Ethics, Staff Support, Engagement) expanded into three distinct programs providing support for cumulative stress, moral distress and secondary trauma. The transition of RISE from a single entity into a comprehensive, multi-program initiative more precisely meets the complex needs experienced by clinicians providing patient care.
Intervention: The expanded RISE structure includes: Resilience, focusing on the cultivation of self-care strategies and resilience factors at the individual and team level; Integrated Ethics, dedicated to processing moral distress and moral residue present in ethically complex clinical situations; and Staff Support, offering confidential support for team members experiencing secondary trauma after patient-related adverse events. An additional domain, Engagement, supports staff when distress presents in overlapping ways, allowing the programs to respond when challenges don’t fit neatly into one category. Each program offers confidential one-on-ones, group sessions, and routine rounding and is led by its own director and staffed by specialists and program managers who oversee trained volunteers. Additional embedded support sessions have been implemented in the Graduate Medical Education (GME) Residency Program to extend support to this traditionally underserved group. The GME support sessions are built into residency for the cardiology, gastroenterology, hematology/oncology, Pediatric Intensive Care Unit and Neonatal Intensive Care Unit rotations. This is protected time for the residents to step away to reflect on their rotation experiences.
Outcomes: Year-over-year increases in RISE requests for support showcase both heightened visibility and an increased culture of support. The expansion of RISE from a single person to multiple directors, program managers, specialists, and the addition and expansion of volunteer cohorts shows the institutional commitment and recognized value of these services. From 2024 to 2025, RISE requests increased by 34% which speaks to the accessibility of the program and a marked 29% increase suggests RISE interventions are not only feasible but meet the needs of those team members experiencing secondary trauma, moral distress and cumulative stress. Preliminary data for the GME support sessions suggests 93% of survey respondents found the sessions “Valuable” or “Very Valuable”, 19% of respondents utilized other RISE services due to the support received in their embedded sessions, and 96% of respondents felt “better prepared to handle and navigate the demands of the residency program” because of the embedded reflection sessions.
Conclusion: Healthcare Institutions have an obligation to support staff by tending to cumulative stress, moral distress and secondary trauma experienced by their staff. A supportive community extends beyond the bedside and requires intentional care for the well-being of team members across the system.
