Posted in Tips and Advice

As a nurse, you face innumerable human tragedies every time you show up for work. You see people at their very worst, on the very worst days they’ve ever had. Ever. You watch people die, right in front of you, while you’re holding their hands and wishing them a peaceful journey. You watch the same people come into the hospital over and over and over for the same preventable problems. You see people who make no effort to manage their own health problems for years yet expect you to work miracles in a 12-hr shift. You are forced to torment the fatally ill when they are at their most vulnerable. And yes, once in a while, you do make a difference. But it’s rarer than you think.

When I was a nursing student, I thought I’d make a difference for my patients every single shift. Working in ICU, it didn’t take long for me to realize that we do a lot of futile care. We torture people far longer than is necessary and for reasons that are simply sad…families arguing over health care decisions, lack of advance directives, oncologists who refuse to believe that stage IV cancers with mets all over the body are actually killing the patient…the list goes on. After going in to work day after day, week after week being witness to all this…how do you hold on to your humanity? How do you maintain your level of passion for your work? How do you feel your feelings, stay present for your patients, and give them your best every time you show up for work? Burnout is a huge problem in nursing, but using these few strategies can help.

Strategy #1: Avoid having pre-conceived notions about your patients.

It is very easy to hear in report that your patient has a long medical history of ETOH, bipolar disorder, COPD, anxiety, DM2 and chronic pain and think…”oh boy…this is going to be fun.” Catch yourself there, before you walk in the room. Throw  out any predetermined emotions you are having about you patient, and get in there and actually assess them. Talk to them. Ask them questions and seek to understand. What you find may surprise you.

Strategy #2: Avoid negative talk at the nurse’s station.

Yes, nurses can be pretty vocal…walk into any break room and you’re going to hear an earful. And yes, sometimes we just need to vent…but make sure you’re noticing the difference between venting and actually demoralizing patients or families. I always try to remember that each patient must have at least ONE redeeming quality (and believe me, there have been times when I haven’t been able to identify any!), but for the most part you should be able to find something in that person that still speaks to you and says, “I’m a person, I’m sick and I’m scared. Please treat me well.”

Strategy #3: Find a healthy way to deal with moral distress.

Moral distress happens to every nurse. Every. Single One. Where I saw it most often was when it came to providing futile care. Either we’d have a patient that a family just wouldn’t let go to have a peaceful death and they’d be in our ICU for months, just lingering on in pain and misery…or we’d have doctors who actually thought they were miracle workers and refused to even broach the topic of comfort care with their patients/families. As the patient’s advocate, you should speak  up when you feel the course of treatment is not aligned with the patient’s best interest. But, be prepared for it to not go anywhere in some cases. When this happens, you will definitely be distressed…having to intubate a 90-year old woman who clearly wanted to be a DNR until her kids show up and change her code status (yes, this happens!), watching a cancer patient waste away whilst undergoing dialysis, aggressive mechanical ventilation and other invasive, painful and miserable treatments…it will become a regular part of your job and how you deal with it will make a huge difference in your own ability to manage the stress of your job. Seek out someone you can talk to…many hospital chaplains will gladly speak to or counsel the nursing staff, or look into employee assistance programs that enable you to go to free therapy once in a while. Maybe it’s just working in an environment where you can go to a mentor who takes the time to listen and help sort through your feelings. Whatever it is, address those feelings. Don’t sweep them under the rug.

Strategy #4: Honor every patient death, in some way.

When a patient dies, you can do one of two things…go on with your incredibly busy shift, or find a way to acknowledge their passing. By taking a moment to honor their struggle, their family’s pain, and your own efforts to alleviate both, you keep your heart in your practice and your sense of humanity intact. One oncology nurse I’ve heard of would always drive to Yosemite National Park when he got off a shift where one of his patients died. He worked 8-hr shifts, would drive the 2-3 hours to the park, go to a special place, say goodbye, then drive home. Granted, this goes above-and-beyond, and I’m definitely not suggesting this level of dedication is needed. But, you could create a small ritual as a way to pay homage to the patient you cared for…maybe it’s a prayer, a meditation, a walk outside in nature, or song that you sing…whatever it is, develop a way to mark the transition so that your heart doesn’t grow immune to feeling something when someone dies. No, you don’t have to cry buckets of tears, but it is important to acknowledge, even in some small way, that a life was lived and lost.

As you work as a nurse, you will have times when you are more impassioned than others. Notice the times when you feel energized…notice what you are doing and feeling so that when you are less than enthused, you can draw on your past experience to get your passion, and your humanity, back into your practice. Your patients deserve it, and so do you.

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