When we make space for meaningful, compassionate conversations around mortality, we address one of the most profound sources of burnout and suffering in healthcare.
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. Alongside us is Sarah Warren, RN, co-founder of Don’t Clock Out (DCO), a mental health nonprofit dedicated to supporting healthcare workers through the impacts of moral distress.
At Introspective Spaces, we believe that patient well-being is inextricably intertwined with the well-being of clinicians. Our mission is to cultivate spaces for healthcare workers that foster reflection, connection, and healing 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 them to engage in both personal and systemic transformation in community spaces across the medical hierarchy. While we wait and long for a more just healthcare system, we aim to reclaim our agency as healthcare workers though caring for one another in a contemplative community.
Don’t Clock Out (DCO) is a peer-led mental health nonprofit built by healthcare workers for healthcare workers. DCO provides essential peer support, acknowledging the critical need for a space 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 and support where healthcare workers feel seen 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—advocating for justice and transforming the care we provide.
EW: What inspired you to start your organizations?
IS (Laura): Introspective Spaces was born from a deeply personal journey that both Anu and I experienced in our healthcare careers. For me, it was an extension of my Christian faith—a desire to live out the teachings of compassion, like those found in the book of James: to “care for the widows and orphans.” Nursing was my answer to the longing to serve vulnerable populations. Becoming a nurse seemed like a perfect way to continue this 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, and I experienced my own moral distress and spiritual injury, feeling helpless and overwhelmed by the systemic issues within healthcare. I experienced panic attacks for the first time and eventually, my physical health deteriorated as well.
IS (Anu): For myself, Introspective Spaces was born out of 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 all the systemic inequities that impacted patients. It wasn’t until years later that I discovered what I was experiencing was moral distress – and I wasn’t the only one who felt that way. My friendship with Laura served as a lifeline for both of us. Even though we came from very different cultural and faith traditions, I could share openly about how my Buddhist faith and values often felt at odds with the injustices I witnessed in the hospital. I realized that spaces to share openly about all the parts of my identity, to be able to mourn patients who had died, to be able to share the emotional and spiritual impact of the work, was essential for me to be able to stay in healthcare.
As we both navigated our careers in healthcare, we longed for spiritual and reflective spaces to process our experiences and reconnect with the meaning behind our work.
We created Introspective Spaces to fill this void, to foster a community where healthcare workers can bring their whole selves, including all the many identities they may carry, into the conversation, as these can be untapped wells of strength and resilience. We believe that addressing moral distress requires more than just self-care; it requires community care, spaces where we can witness each other’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 ultimately reimagine a more just and compassionate healthcare system.
DCO (Sarah): When I graduated nursing school I experienced a traumatic event that led me to going to therapy for the first time. I was the first person to openly talk about my mental health and seek help in my family. I wasn’t in crisis but I knew that I didn’t have the tools I needed to cope with what I had gone through. Seeking help allowed me to identify 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 something that was missing for healthcare workers was peer support led by healthcare workers. In fall 2022, I started facilitating weekly peer support groups for nurses and eventually our team grew to an interdisciplinary group of healthcare workers. We have been hosting these groups ever since.
When I was at my lowest as a bedside nurse what I needed was to know I was not alone. I needed to know I wasn’t the only one struggling with institutional betrayal and the injustice impacting my patients and colleagues. Through peer support outside of the systems that intentionally and unintentionally cause harm, we have created a safety net for healthcare workers who have felt isolated and abandoned. I hope that as our work expands, we can be a catalyst for a culture in healthcare that nurtures and supports the people who care for people instead of exploiting their empathy.
EW: Over the years, 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 or two that have particularly impacted you?
IS (Laura): As a new grad oncology nurse, I experienced a crescendo of moral distress, as I watched patients endure unnecessary suffering. I regularly experienced terminally ill patients who had expressed their desire to stop treatment and find peace. However, for a variety of reasons, including lack of conversations, family wishes, fear of death, and diffusion of responsibility, I was tasked with carrying out orders that I knew were only causing more pain.
This patients’ suffering weighed heavily on me. I felt like I was contributing to their pain, prolonging their life against their will, and not because it was in their best interest, but because the healthcare system wasn’t equipped to give the time, space, or skills necessary to have hard conversations. There was often a diffusion of responsibility; no one took ownership of discussing the reality of the patient’s situation. As a nurse, I was unprepared for this type 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 that the well-being of patients and providers is interconnected, and 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 daily physical pain and for the first time, I could see why people in pain, without any judgment, decided to take their own lives.
As nurses, we sign up to accompany suffering, to care for patients as they face disease and death. But the unnecessary suffering caused by systemic issues—lack of staff, lack of time, and a focus on profits over people—was something I wasn’t prepared for. It became clear to me that moral distress, this emotional turmoil caused by knowing what’s right but being unable to act on it, wasn’t just a personal struggle but a structural problem in healthcare.
This experience, along with many others, ultimately led me to connect with the mission of End Well. I believe that when the end-of-life experience aligns with a person’s values and goals, it not only honors the patient but also alleviates 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 seen as a measure of living well, we can radically reduce the moral distress faced by frontline workers, families, and caregivers. When we make space for meaningful, compassionate conversations around mortality, we address one of the most profound sources of burnout and suffering in healthcare.
EW: In your experience, what are some significant societal norms or beliefs about mental health, healthcare and end of life that you feel need to be challenged or redefined?
IS (Anu): Healthcare still continues to deeply stigmatize issues around mental health and grieving. Even though we care for people in the most vulnerable moments of their life, we don’t have the opportunity or bandwidth to hold space for all the complicated emotions that come up for patients as well as our colleagues who witness these challenging experiences daily. Even during my medical training, if a patient would die during our shift, we would continue working and caring for other patients without stopping. While we absolutely need to continue caring for patients, I really struggled with the lack of space to grieve and mourn.
Healthcare needs spaces where healthcare workers can be vulnerable with each other and process their experiences in community. Organizations such as Don’t Clock Out are an amazing resource for healthcare workers to be able to talk about their mental health, moral distress and grief in a non-judgmental community space. Spaces such as End Well are absolutely essential for normalizing the physical, emotional, social, spiritual and mental health impacts of grief. At our Introspective Spaces retreats, grief and mental health are huge themes that come up organically and we utilize modalities such as art, contemplative practice, and reflection to allow participants to begin to bring these experiences to light. By engaging in conversation in community, we are able to tend to our mental and physical wellbeing and feel less alone. We are grateful to work alongside such amazing organizations who are 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. Can you tell us more about what attendees can expect, and why you chose to collaborate with us?
IS (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 day 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 around mortality. We hope this drop-in sanctuary offers an opportunity to travel from the rich insights of cerebral work to the embodied experience of the feelings that may come up over the course of the day.
Whether attendees wish to engage in narrative writing, movement, poetry, meditation, or collage, the Feelings Space provides opportunities to pause and process in a meaningful way. Rituals and expressive art will also be available for those who want to honor loved ones who have passed. Attendees can come and go as needed, maintaining connection with the conference while stepping into this space for reflection, creativity, or solitude.
DCO (Sarah): Over the last 2 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 are able to do so with a group of peers, we can begin to honor our shared humanity and experiences in realizing that we are not alone. The themes covered at End Well can bring forth complex emotions; having a container that is open and welcoming to share and be supported, may encourage folks to take steps towards their own long term healing.
EW: What was the most surprising or memorable aspect of last year’s End Well event for you?
IS (Anu): Last year was my first year attending End Well. Prior to attending, I didn’t know much about End Well aside from their mission to support caregivers, clinicians and patients with navigating grief and loss. When I attended, I was blown away by the beauty, depth and vulnerability of the event. Listening to the diverse range of stories helped me unlock feelings of repressed grief within me from my years of medical training. It felt wonderful to be in a space with so many kindred spirits who were open to having the hard and necessary conversations about what it means to live and die well. I loved everyone I met that day and I’m really excited to attend this year’s event.
DCO (Sarah): Last year was my first time attending End Well and I was given the opportunity to bring a group of friends to join me. We had a group of about 12 interdisciplinary healthcare workers, patients and caregivers who got to experience End Well in community. This experience brought us closer together as we opened up 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 in that we get to experience End Well this year through a new lens of holding space for people who care for people. Through offering peer support, though complex emotions that may come up, we begin a long term process of identifying what we feel and what we can do to support ourselves and each other in response to those feelings.
EW: Looking ahead, do you have any upcoming projects or offerings that our 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, which focuses on addressing Moral Distress in Healthcare. This initiative is designed for healthcare professionals who want to dive into the emotional and ethical challenges they face in their work, providing them with tools and strategies to navigate moral distress while prioritizing their well-being.
Our mission is to create community education for healthcare workers, by healthcare workers—rooted in the radical reimagining of what caring can be. We believe that shared wisdom and collective action are foundational to building a more just, equitable, and abundant healthcare system. By coming together in this way, we can work toward a future where both patients and providers are supported, ensuring that care is rooted in compassion, justice, and a commitment to well-being for all.
You can learn more about this offering and register here: [Reimagine Healthcare Collective – Moral Distress](https://reimaginehealthcarecollective.com/moraldistress).