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Split Personality

I think one of the most difficult parts of a nurse's job is having to compartmentalize what is going on with one patient to deal with another's issues. Unlike many other jobs. Nursing is heavily regulated by privacy, the expectations of professionalism, and the obligation of a nurse to respond on an emotional level to a patient's needs because nursing is synonymous with caring.

On a patient day when in one room a patient is recovering, he is happy, his family is thrilled and the mood is light. The nurse while in that room is a part of that celebration as an extension of having been the one to deliver the care provided to bring the patient to that destination. The nurse is uplifted and reinforced. What I do is working, what I do is good.

In another room, a patient is struggling to survive. The family anxiously sits, overwhelmed by what is happening. Struggling to comprehend why this is happening to them, to their loved one, why right now, how will we handle the loss emotionally, financially. They may not have the skills. The nurse will either provide assistance with coping or will facilitate additional resources such as a chaplain, contact with further family members, a social worker, palliative care. But even with the addition of these resources. The nurse is the hub of the wheel and information from all these sources will funnel to the nurse to use and store and pass along. In this room the nurse is weighted down. The treatment delivered is not going to lead to healing and recovery. The best that can be hoped for is a good death. Whether or not the family has prepared for this. The nurse has some responsibility to get that preparation on the fast track and communicate with a multitude of others on the care team and help this family arrive at a place of coping.

In the end, the nurse will give report, gather belongings, put on the coat and get in the car to go home to reports of how school and work went, laundry that needs done, family celebrations and may not be able to share what huge emotional territory she traveled that day. After months and years of this, it takes a toll. The fabric of a nurses psyche is woven in complicated and rich patterns due to the demands of everyday work. It is other nurses that nurture and heal these places. They have the necessary understanding and empathy to feed, heal and bring laughter back into place. Nursing is unique in its demand to compartmentalize work and life, one patient and another on such a deep level. It is important for nurses to assist in the process of healing for other nurses.

fawnmarie, ASN

Specializes in Psychiatric Nursing.

Well said, and so true.

"obligation of a nurse to respond on an emotional level" is the key point.

We have the obligation to respond accordingly. We need to critically think and use our resources to the patient's benefit. We carry out plans of care.

Once a nurse starts responding on an emotional level is when a nurse needs to step back and re-prioritize.

Life outside of the facility is where we need to respond on an emotional level. At work, we need to respond, but keep emotions out of the picture.

Jadelpn I really appreciate your comments about critical thinking and professionalism, but I disagree that there is no place for an emotional response in the nursing profession. We have a job that requires us to develop a connection to people. Our clients know when we are approaching them solely on a distanced professional level vs genuinely caring about their well being and outcome. What we invest in our patients is on a similar level to the creative energy an artist puts into their work. It does deplete you somewhat, but then again other interactions fill you back up.

I think we can develop a professional connection to people/patients. And be quite genuine in wanting a positive outcome for a patient. And be professionally invested in a plan of care that works for a patient. It doesn't have to be distanced, however.

We can show compassion, empathy and desire for good patient outcomes without having to emotionally connect with patients. By striving for and seeking out that level of connection, we can put our own emotional needs as equal to that of the patient.

Jadelpn I really appreciate your comments about critical thinking and professionalism, but I disagree that there is no place for an emotional response in the nursing profession. We have a job that requires us to develop a connection to people. Our clients know when we are approaching them solely on a distanced professional level vs genuinely caring about their well being and outcome. What we invest in our patients is on a similar level to the creative energy an artist puts into their work. It does deplete you somewhat, but then again other interactions fill you back up.

I would disagree that professional automatically equals cold and distanced whereas emotional equates to personable and compassionate. I have met many professionals in the medical field that provide excellent, compassionate and professional care--but they don't take the troubles of the patient home with them. I've also met people who become so emotionally attached that they can't let it go--or they're such emotional messes themselves that they're incapable of providing patient-centered care and instead insert themselves and their desires into the situation. It is quite possible to be a professional nurse who connects well with his or her patients, but doesn't become emotionally involved.

Having cared for oncology patients as well as wounded warriors, I know the difference between both types of attachment very well. One is a healthy relationship that promotes autonomy and empowers the patient. The other one is a drain on both parties. It's a lesson often learned the hard way, but an important one nonetheless.

NurseGirl525, ASN, RN

Specializes in ICU.

I think it is hard not to let emotions get mixed in nursing but I certainly understand where the mindset comes from. At the facility where I am doing clinicals, I was talking with several nurses about this same thing yesterday. They all told me you can't get too close to the residents as you would always be sad. They told me a couple always break through and happen to steal their hearts but for the most part it's too painful because they all die on you. I find it easier with a most of the residents not to get too close because most have some type of dementia and usually don't know who you are an hour later or the others by the end of the day. I'm not there every day so it would be very hard if I was there all of the time. Sometimes I get super sad when I watch a gentleman just listlessly look out the window all day or my heart gets filled with joy by the elderly couple that lives in the facility together and she is much worse off than him and he still tries to care for her. His face always lights up when we bring her back. I honestly want a love like that someday, where after all these years his face still lights up at the sight of me. But I also am comforted by the fact that these residents have families who come and see them often. And it's pretty much all of them. I think it's better for me to know that they have people to care for them and that I necessarily don't have to.

I guess the question is: Do we choose to get emotionally involved? or Do we get emotionally involved because of what we chose to do? I empathize with my patients, I understand what it is to lose a loved one, I understand their fears of not knowing what is going to happen to their future. The look on concerned loved ones faces with the illness of the patient and how to help him/her, their helplessness. This is partially cured by providing them with the tools to empower themselves to take care of their illness and the plan of care that addresses the whole patient and all that encompasses his/her recovery. However, when they are released to the outside world and perhaps do not have the resources available to them to prevent another acute occurance is when I get emotionally over-loaded. You know the patient who you will be seeing again in about a month from a prior admission. Where did the system fail? By taking our emotional energy and applying it to a process that will ensure the patient gets the services he/she needs in the community will perhaps help to prevent overload for us. A way we can help in this manner is by assisting case management by notifying them as soon as we suspect a patient is going to need extended services upon discharge, and by possibly volunteering ourselves in our communities to organizations that provide these services. Perhaps this will help to prevent another frequent flyer from coming in a month after a previous acute event. Try to really apply yourself with your patient education, do more than just hand them the print outs from the computer program. Discuss with them why they need to follow-up with their PCP, why they need to take their medications as ordered etc. All these little bits and pieces can come together to make a huge impact on our patients.

I can be appropriate and show caring, delight, sadness, and anger, but the minute it starts being about me, it's less about the patient, and that's unprofessional. "Compassion" does not mean what a lot of people think it means, as my beloved Fezzig used to say.

As you become more experienced, you develop a genuine appreciation for what they tried to teach you in nursing school about personal and professional boundaries. Look up some of the threads on burnout, too, while you're at it.

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