Caring too much - does it make you cynical?

RNperdiem, RN · Jul 7, 2009

I could see a person becoming cynical if they require the people they care for to acknowledge the care and be grateful for the care they receive.

If "caring" does not draw a line between a personal and a professional relationship, then that can lead to problems.

Mike A. Fungin RN · Jul 7, 2009

Your background that you describe is not all that uncommon for nurses and other helping professionals. Many of us grew up in families with issues like alcoholism and codependency.

One of the greatest assets someone who grows up in an environment like that is their great capacity for caring. But if you can't set healthy boundaries and know when to rein yourself in, it can come at a price. My advice is to talk with a clinical advisor or professor you trust, as well as your classmates, about what boundaries they set for themselves in their caring for patients.

braddah · Jul 7, 2009

Thanks much! I will start talking to my professors and other class mates about how they coping with it. Yea, I agree, I better get this sorted because the last thing I want is this to affect my practice however, thank you for your advice it means heaps.

epiphany · Jul 7, 2009

Becareful not to let your caring be a codependency. You're not going to happy if you don't recognize it and deal with it, especially in a profession of caring. Here's a link to signs for codependency. It happens to a lot of people obviously, or the term wouldn't be coined, so you're not the only one.

http://www.codependents.org/tools4recovery/patterns.php

braddah · Jul 7, 2009

thanks for that!:)

Trauma Columnist · Jul 7, 2009

There has to be a "separateness" for lack of a better word between you and your patients. You are not the patient, you are the caregiver. However, for the most part, your patient plays a more important role in getting healthy. At least that is the way it should be.

That said, most of my nursing exp is in the ER - a big, inner city ER at that. Many of my patients were there legitimately, for bonafide emergencies. Then, there were the others: the mentally ill, the drunks, the high folks, the homeless who had no other outlet other than the ER. They did make me fairly cynical. However, cynicism is a form of coping too: you just can't bleed for everyone.

Take care. The fact that you recognize this is great. Good luck in your nursing career.

nursemike, ASN, RN · Jul 7, 2009

There is, I sometimes think, an element of hypocrisy built into nursing. At its worst, we can find ourselves "pretending" to care about a patient, or a patient's family, who is driving us nuts. You may have to swallow pretty hard to smile and say, "Can I help you?" to someone who has been on the call light q15 minutes for the last six hours. That's not unique to nursing, of course. Anyone in a "customer service" role (and we definitely are!) faces the same challenges.

But the problem can be more subtle when you actually like your patients, because even then you have to keep a degree of detachment. On a fairly superficial level, this means that no matter how much you care, you can't take them home with you. Cry in the parking lot, if you have to, but don't let work follow you into your private life--and vice versa. Even tougher--for me, anyway--is that you have to look at patients as a "case," as well as a person.

That sweet, funny old lady with the adorable grandkids is also a set of vital signs and collection of symptoms, and you can't console someone out of a-fib. When that 40 y.o. loving husband and father with a glioblastoma asks, "Am I going to die?" you owe them better than "Oh, no, you'll be fine." (As a nurse, I don't prognosticate, so my answer is basically, "I don't know." although I try to find a line between false hope and no hope.

I've recently had to care for my Dad through some serious illnesses, and that has underscored to me that I can't be his nurse. I know more about his illnesses than a lay family member might, but I can't be detached. That sore on his foot was bad, obviously, but it was getting better, right up until they took his toe off. More recently, I had to convince him that if he didn't go to the hospital, he would die. Finally succeeded, and thank God and the docs, he's doing okay (CHF exaccerbation) but we cut it way too close, in part because I could only speak to him as a son, and not enough as a nurse. For me, one lesson in this is that at work, I am obligated to be the nurse, even if it isn't "nice."

I'm lucky. I'm at an age where my own mortality is no longer seeming entirely theoretical. Gives you some perspective on the mortality of strangers. I'm also working on a neuro/neurosurg floor. As serious as the problems of our patient population are, a lot of times they aren't too painful, and frequently not mortal.

The patient back for the third surgery on that glio knows the score, so your focus is on helping them fight as long as they're willing. The really bad strokes are a.) unresponsive and b.) a lot less common, these days. More typically, you are dealling with someone who will survive this stroke, so you try to balance keeping them safe and starting their rehab--don't get out of bed without help, but you have to get up to the chair for breakfast.

Getting back to the OP, I do think you can do this without getting cynical. It's hard. Honestly, I feel it's necessary to open your heart. It's a big part of what led me into nursing, and even clinically, a lot of what I do is intuitive. One of the keys to my assessments is neurological status. I do, every shift, ask every patient their name, where they are, what day it is, but a lot of my neuro questions are , how do you feel? do you need anything? isn't that a shame about Michael Jackson? AOX3 is important, but neuro status is a complicated thing, and you can pick stuff up in casual conversation, or sometimes you can just "feel" that they aren't quite the same person they were yesterday. Then, too, I think they recover better when they feel cared for. So, I've got all these rational reasons for caring, but mostly I just do, and I'm okay with that, and even with the PITA's, there's usually a person there that I can find something to love about. And sometimes patients know they're annoying me, and maybe that isn't so bad, either, because I really think it's important to be genuine, because almost all of them can see right through fake.

In my philosophy, happiness and fun are not the same. Fun is part of happiness, and so is joy, and so is heartbreak. My heart can bleed for the 18 y.o. onc patient we got on overflow, but she isn't my daughter, and I can have a good shift caring for her. I mentioned "hypocrisy" earlier, but sometimes its more a matter of schizophrenia. You gotta be able to live in several realities, and try not to let them bleed into each other, too much.

braddah · Jul 7, 2009

hey,

im just reading through all of these comments and yes i do sometimes get cynical with patients BUT i remember they are sick and are most probably not like that when they are well and with that thought it kind of 'calms' me.

Just to clarify, i am being more cynical to healthier people in the parks and all because if you think about it...you only care for people who have issues..so all you see are issues...

is there are way in detaching from this? its difficult because these 'issues' are what is in society so its hard to not be cynical to those smiley faces you see :)

back to the link that was given earlier and it helped alot thank you.

Your philosophy is great nursemiike! it sounds like me! :)