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On Call: Leadership in Nursing

The Cost of Caring

Published July 19, 2016 8:34 AM by Martie Moore

Suddenly there it wasa lack of compassion. Or was it?

She was only 29-years-old when the phone rang with news no one wants to hear. She didn't believe it at first, and neither did her family. Then it became reality-more doctor appointments and finally surgery scheduled for a double mastectomy. She had ductal carcinoma, highly aggressive, but caught early. The funny part was she felt something was wrong long before others believed her. Her doctors informed her young women her age do not get breast cancer.  She made a joke of it and said, "I guess they were wrong." 

The day she went in for surgery, I and her family were present to hug and love her. She made a request of me: tell her the truth when she came out of anesthesia. Being her aunt and a nurse, I knew the rhythm of the operating room and recovery thereafter. My family and I watched the board to see the colors change and knew where she was in the surgical process. As the clock went around and around again, her holding time in the recovery room became an outlier. My family was worried (and, frankly, so was I) that she was not moving up to her inpatient room. We could not go back and see her and later learned room availability caused the hold-up. When a room freed up hours later, we finally got to see her for the first time. 

As she came through the door, we were waiting. She acknowledged her husband, parents and then turned to me and said, "Did they get it all?" I was the truth teller, and she knew I would hold my promise to her. "Yes, sweetie. They got it all." Heavy emotion hung in the air as her words and my words drifted together. Suddenly a voice, crisp and matter-of-fact said, "Come along folks. We cannot stand here in the hallway forever. I have to get back to my other patients."  

There it was, the moment when a perception of compassion was lost forever, replaced instead with feelings of anger and judgment by me and my family. 

The question I had to answer to myself was the why behind the action of the nurse. It is clear that in today's healthcare environment we move throughout the day in a rhythmic way, addressing the tasks. Was she so deeply connected to the next "to-do" that she failed to see the human suffering before her? Was this the fifth patient today who had a life threatening diagnosis and surgery, and she just couldn't be present to the raw emotions anymore? The nursing profession is doing a better job of trying to understand compassion fatigue. Could self-care be missing and she just didn't have it in her to be empathetic one more time? In essence, her cup was empty? 

I will never know the "why" of the nurse and her actions that day. I don't know if it matters. I do know it propelled me into greater understanding of how emotionally tired nurses are across the country today. In the coming months, I will share with you some of my learnings and what you can do to help yourself be a healthy nurse with the ability to be resilient.

How real is compassion fatigue in your life, and what do you do to fill your cup?


Last month, I shared with you a very personal story that jump-started my quest to further understand

August 19, 2016 8:13 AM

Christine's response hurt me deeply; "I loved nursing but nursing doesn't love back"... sooo true!

We were warned in nursing school that "Nurses eat their young". For me, it had to come to Why do I do It?! Not for anyone else (except my children and husband...OK, for the patient's too! When I DO make a connection, I know then that my actions are appreciated. I have been a nurse for 24 years, and my nursing school instructors gave me sage advice (that I have passed on to "New Nurses" since then); #1:Get at least two years of Med-Surg experience. #2: Don't stay on the same critical care floor more than 4-6 years.

Although my timing has not been that exact, I have "re-invented" my nursing career three times; changing jobs when I felt and knew that I was "burnt out". How did I know? Depression, quick to anger, morbid humor, cynicism. Not the best of traits. I didn't feel appreciated by my supervisors. How do I survive?  I read lots of medical journals, I love to learn of new innovations, I have supporting co-workers where we are our own Appreciation Society! I laugh and try to find humor in life. We as nurses give lots of ourselves to others, we just need to remember to save some of us for ourselves!

Janice, Case Management - RN, Dept. of Health July 29, 2016 9:03 AM
Jacksonville FL

I think it burn out all together no matter what aspect of nursing you do. I have been in nursing for over 25 years and over the year it just more and more work and less staff to do it. It feel like their sucking the life out of you and ever day you have to put on the happy face even though you wish you never had to work again. It all about meeting  criteria not that they really Need to stay a little longer and They push them out the door just to turn around and be re-admitted. Feeling like your there just to push the pill , do the tx and have no time to give any Compassion or   emotional assistance as us have 10 min per patient when your have 20 or more people to give your time to and squeeze in as much time as you can during that interaction to give that  moment of compassion and to make them feel you understand and care.

Linda , Geriatrics - Lpn , Assist living /insurance July 29, 2016 12:51 AM
Albany NY

This article could not have come at a better time for me.  I have been working as a Psychiatric Nurse/Chemical Depend for 25+ years.  I have loved my job and the work I do, have a wonderful boss and great pay.  I have been racking my brain trying to figure out why I don't want to go to work anymore. I'm drained and tired, and have found myself (one who smiles most of the shift) frowning and becoming distant and withdrawn from my important work. I have decided to retire.

Diane, Psychiatric & Addiction - RN July 28, 2016 2:45 PM
Santa Barbara County CA

Very important topic to address to get nurses talking about the truth...."Nurse Burnout is PTSD".  I have been a nurse for 40 years and so many times I have had people say " You're a nurse, you are used to seeing these things so it doesn't bother you".  I can't tell them that at age 23 I cared for my father who was suffering with the intractable pain of bone cancer and 8 years later I was in the hospital and under psychiatric care for Anxiety Disorder/PTSD. It took the 3rd psychiatrist to figure out what started this disorder and that was because he took the time and LISTENED !!! No....I never get used to seeing these things.        We need educate the PUBLIC about the hospital execs and the government who have turned today's health care system into a widget production job rather than a patient caring job so they can

bombard them with their complaints.

Ann July 28, 2016 9:16 AM

I do not think it is compassion fatigue but just plain fatigue.  Nurse to patient ratio, acuity of the patients, long hours and short pay.  I am a 60 year old nurse currently working as a clinical nurse educator who has spent most of my career in the ED.  With the current workload and the task oriented and driven electronic charting, it amazes me how compassionate nurses are.  They will give up lunch, going to the bathroom, and overtime to care for patients.  It also amazes me that healthcare facilities do not understand or recognize that and continually require more.  I am not the author of the following statement but fully agree with it.  There is not a nursing shortage but a shortage of nurses willing to work under the current conditions.  Thank you for this forum.

Deborah July 28, 2016 8:26 AM

I  have been a nurse for 23 years.  I understand everything you are saying.  But the public doesn't understand the profession of nursing.  They don't even think of us as a people.  The doctor can make them wait for hours and when they do show up they're hero's. We make them wait 5 minutes for a cup of coffee or extra blanket or pain medication and we don't have compassion or we are incompetence. Every once in a while i look at another patient at the end of a twelve or 14 or 16 hour day and I don't even see them. We are a dying art. I got into nursing because I loved caring for people. Now I feel like I have changed into a totally different person.  I loved nursing but nursing doesn't love back. It used to be my passion  loved going to work.  I have held hands of people dying and people giving birth. I have amazing memories. I have a bad back bad knees neck pain and headaches every day. We nurses need to get together stop this epidemic before it effects us all. I know I have PTSD but no one understands how a nurse could possibly have that. That's for soldiers and rape victim or child that have been abused. Nurses can't possibly have this. We do and we have.

Christine, Surgery - RN July 27, 2016 8:53 PM
Gainesville FL

I finally retired ten years ago after 43 years of nursing. How I loved it, and how many times I did burn out in the hospital.  It wasn't called PTSD then and not recognized then and even now by psychologists or licenced social workers.  How I wish this could be addressed to the therapists who treat people who haven't forgotten some heartbreaking incidents even into their seventies and don't recognize what they are experiencing.  

From an old fashioned nurse who addressed the whole person and not just specific problems.  

Fran Caspe, many and too numerous to state here - retired R.N., visiting nurse, staff development, LTC and public July 27, 2016 7:48 PM
Boston metro west area andNYC MA

Thank you Melissa for sharing your insight. Your wisdom is very much valued.  I like to say that many Nurses see in the course of a shift what most people do not see in a lifetime.  Nurses have high expectations of themselves and many times do not give themselves permission to acknowledge their humanity.  PTSD is very real within the nursing profession.  Thank you for opening the conversation about it.  

Martie, , CNO Medline, Industries July 22, 2016 1:19 PM
Mundelein IL

I have been a nurse for 39 yrs, and yes I have been there emotionally nothing more to give. I am sure that nurses who see the tragedy, the intense suffering and horrific side of life do suffer in silence. We are to be stoic and be strong for others.  At least this is my own perception from being in several areas of nursing throughout my career. I honestly believe there are those of us who suffer from PTSD and it has not be addressed. It is engrained in us to carry on regardless of things  going crazy around us. I appreciated your article from a different standpoint as a family member of a pt. I have been on both sides as well and even been the one on the stretcher coming out of surgery. For the majority of my experiences as a pt/ family I have seen compassion but I had a sense the nurses were overwhelmed and trying to do the best with what they had and could give. Thanks for letting me voice my experiences and open this topic up.

Melissa Evans, Med/ Surg - RN July 21, 2016 1:07 PM
Knoxville TN

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