The battle against burnout

Nurses bring our passion with us; otherwise we wouldn’t have chosen this job and stuck with it. Passion led me to trade my previous career as an English professor at Tufts University for nursing. But despite our intense commitment, and our best efforts not to let the job burn us out, the emotional pressures can be overwhelming, even during one 12-hour shift.

Another hospice patient, another recent hard day: In his late 60s, this patient’s turn for the worse had been sudden, and the family had been told that nothing could be done. He was on a dilaudid PCA, his kidneys had shut down and he was completely non-responsive. But—how can I say this? The man would not die, and the waiting and watching was grinding his family down. He had been my patient for two days, but he had been CMO (comfort measures only) for at least four. By the end of my last shift with him, his wife was feeling the strain terribly. Over and over again, she asked if the pattern of her husband’s last days was normal. What would happen and when? Should we, or she, be doing both more and less? Was he silently suffering?

I understood how she felt, I empathized, but by the end of shift I was running out of emotional steam. I tore myself away from the last conversation I had with her. “I’m really sorry,” I said, “but I have to draw some blood in the next room.”

I did have to draw blood—timed labs that had to be sent down on ice. The truth is, though, I left the room because I couldn’t take it. I finished up what I needed to do, checked in with the nurse taking over for me on the night shift and left.

Waiting in the hall, I pushed the down button on the elevator, and then decided to take the stairs: That’s how urgently I felt the need to get off the floor. I relaxed only when I reached the lobby, where I felt safe from the wife’s needs and my own impulses to care.

I can’t say I’m proud of how I acted, but I don’t judge my behavior, either. How do I do this job? By acknowledging that however much I may try to act—or even feel—otherwise, at the bottom I’m always all too human. Nurses tend to give until it hurts, but if we do that every day without reserving some generosity for ourselves, pretty soon we won’t have too much left to give.