When you stop caring about your patients

prelift · Jul 3, 2017

Our minds get used to things as we continually deal with them. It is not wrong to not have some deep empathy toward patients. We have a duty to do what is best for them, nothing else. With a judgement of duty; empathy, compassion, etc is not required and it takes less of a mental toll on us when we work out of duty instead of an emotion.

Tacomaboy3 · Jul 8, 2017

it takes less of a mental toll on us when we work out of duty instead of an emotion.

Well put, I like and agree with this.

Columnist · Jul 11, 2017

Moved to General Nursing for more response.

TriciaJ, RN · Jul 11, 2017

You can feel somewhat bummed that you couldn't save someone, but deep emotional responses should be reserved for your own loved ones if at all possible. Human beings can get used to a lot, and getting hardened to things is how we survive them. If you allowed yourself to take it really hard every time you lost a patient, you will eventually become numb to everything. That includes the illness and death of your own family members.

When we're young and idealistic, we take pride in "giving our all". As we get older and seasoned we learn the importance of holding something back for ourselves and our loved ones. Our longevity in this business depends on it.

macawake, MSN · Jul 11, 2017

I feel like I am deep in a compassion fatigue phase right as yesterday I didn't really feel any emotion when my elderly patient passed away. Just saying that makes me feel terrible, but it is true. I think being in a very busy ER has a lot to do with it, because that is not who I used to be.
Can anyone else relate?

I think that feeling the way you do is a normal reaction to an abnormal situation. Depending on the specialty we work in we can witness death pretty much on a daily basis, or at least on a regular basis. Not only do we witness death, but we also experience the raw grief of the patient's loved ones in a very "in-your-face" manner. As resilient as us humans are, it's still not surprising if that takes a toll.

I am actually heartened by the fact that you feel terrible. Not because you feel terrible of course, I really don't want that for you, but because it shows you do care. There's nothing wrong with your reaction, it's something many professional caregivers experience at some point in their careers.

I think that working as a nurse, perhaps especially in an ER or ICU type environment, requires a balancing act. You do not want to lose your capacity for empathy, but at the same time you can not afford to absorb and harbor all of your patient's and patient's loved ones emotional pain and grief. That's simply too heavy a burden to carry. It would negatively affect your ability to perform your professional responsibilities and it would be detrimental to your own health. I think our psyches does what it can to protect us when the it becomes too much.

At the risk of sounding trite, I still want to offer some very basic/standard advice. Perhaps you already do all of these things; but try to get enough sleep, eat healthy and above all; exercise! I genuinely think exercise is one of the best "de-stressors" out there. Personally, no matter how emotionally "off-kilter" I might feel, exercise never fails to make me feel better. Also, spend your free time with people who make you happy and do things that give you pleasure and happiness.

I definitely don't mean to downplay what you're experiencing or imply that you can just exercise it away, because compassion fatigue is a real thing. While healthy living and spending time with loved ones is a very good foundation to build on, adding counseling might also be beneficial to fortify your "emotional health self-defense" regimen.

I know I said that I think it's a good thing that your present lack of empathy bothers you to some degree. The only reason I feel that is that I see it as proof of human goodness and kindness in you. But I really, really don't want you to feel terrible. Don't feel guilty about something that's the product of witnessing more deaths and grief up close than most people thankfully have to experience in a lifetime.

I wish you all the best, OP!

Take care :)

JKL33 · Jul 12, 2017

I feel like I am deep in a compassion fatigue phase right as yesterday I didn't really feel any emotion when my elderly patient passed away. Just saying that makes me feel terrible, but it is true. I think being in a very busy ER has a lot to do with it, because that is not who I used to be.
Can anyone else relate?

Hmm. You know, I really think that unless you are experiencing other symptoms of emotional distress, this one event really shouldn't provoke you to label yourself that way. I'm just thinking out loud - - only you know. All I can tell you is I've been in the ED for a long time and I seem to have phases where things affect me more overall. Just about the time I start questioning myself a little (like you are now), I'll encounter a situation that hurts terribly.

Sometimes, for some people, the death of someone who lived a good long life is not the thing that tugs our heartstrings the worst. Maybe it's some other suffering in the world. You may find this odd but pts experiencing psychosis (especially new-onset, such as new-onset schizophrenia) make my heart nearly physically ache...I hate it even more if physical restraint is necessary...they are so terrified, and it shows. I've walked out of rooms and cried a time or two.

Sometimes it's just some other type of suffering that we "feel" more acutely. A sad family situation, a bad diagnosis, etc. Sometimes it surprises us. Sometimes a lack of a particular feeling is what surprises us, as you are experiencing now. This is all part of the experience of being human, and of caring for others.

I would be more concerned if you'd said you don't perform your duties well because you don't care what happens to people. But that's not true, is it! So I say, realize the ebb and flow of life, give yourself a break, keep giving good care. Don't label yourself or diagnose yourself with "lack of compassion." If you are concerned, truly concerned about yourself beyond this one incident, talk with a trusted person who understands your work.

macawake, MSN · Jul 12, 2017

@JKL33, just wanted to let you know that you write plenty of smart, kind and insightful posts :up: Excellent post!

prelift · Jul 13, 2017

Will probably get hate from this but some of the best docs/nps/etc I have known are problem fixers. We really are all problem fixers. If i call an AC repair dude to my house I do not want sobby empathy, false tears, and what not. I want my AC fixed. They look at the whole AC (the good ones) when they fix it by asking about usage, which filters I use, and what could have gotten in it--- addressing the problem at the root cause.

Same thing when we ask a patient about asthma. We dont just throw them an inhaler. We ask questions on how to modify, prevent occurrences, etc.

This "whole person" crap does not mean a thing if we are already searching for the root cause of a problem.

Be friendly, non judgmental, and do your physical duties. That is all we owe patients.

JKL33 · Jul 13, 2017

Will probably get hate from this but some of the best docs/nps/etc I have known are problem fixers. We really are all problem fixers.

No hate from me; I can identify with what you're saying a bit. I've been scoffed at before for saying I'd rather have a doctor who's excellent/expert at what s/he does, than a hand-holder/sympathizer. I have cherished family relationships for my emotional connections. As long as one is able to uphold the ethics of this profession and act in another's best interests (such as nurse/patient relationship)....there is room for lots of different types of us. I say all that and yet what I wrote above is true too. Human beings are awful hard to put in a box!!

macawake, MSN · Jul 14, 2017

Will probably get hate from this but some of the best docs/nps/etc I have known are problem fixers. We really are all problem fixers. If i call an AC repair dude to my house I do not want sobby empathy, false tears, and what not. I want my AC fixed. They look at the whole AC (the good ones) when they fix it by asking about usage, which filters I use, and what could have gotten in it--- addressing the problem at the root cause.

Hate? I have a different opinion.

Human beings aren't exactly air conditioning units, are they? By the way, what makes you say false tears?

My best friend is a cancer survivor. She's told me that she's eternally grateful for modern medicine and the physicians who treated her, but she says that she owes her will and ability to fight through what turned out to be quite painful and scary side effects from her cancer treatments, to the nurses who saw and acknowledged her suffering and gave her strength with their caring and supportive attitudes.

I think that you might be underestimating the healing power of empathy.

I think the trick is to find/strike a balance where we can offer support to our patients, but not at the expense of our own emotional health.

This "whole person" crap does not mean a thing if we are already searching for the root cause of a problem.

I respectfully disagree.

CardiacDork, MSN, RN · Jul 14, 2017

Will probably get hate from this but some of the best docs/nps/etc I have known are problem fixers. We really are all problem fixers. If i call an AC repair dude to my house I do not want sobby empathy, false tears, and what not. I want my AC fixed. They look at the whole AC (the good ones) when they fix it by asking about usage, which filters I use, and what could have gotten in it--- addressing the problem at the root cause.
Same thing when we ask a patient about asthma. We dont just throw them an inhaler. We ask questions on how to modify, prevent occurrences, etc.
This "whole person" crap does not mean a thing if we are already searching for the root cause of a problem.
Be friendly, non judgmental, and do your physical duties. That is all we owe patients.

I work with human beings, not A/C units. I will take into account my patients from head to toe. I always maintain healthy boundaries, but my duty as a nurse is NOT ONLY to advocate for the restoration of their physiologic integrity, or physical comfort when faced with a terminal diagnosis - but to provide my patients and their families that I am on their team, I am on their side. I support their decisions. I will try my best to practice healthy doses of empathy.

This does not mean I need to cry or be upset because someone dies. It means being their cheerleader, not being afraid to hold their hand when they are in pain or when they have gotten up for the first time after weeks of being intubated. It's that special touch.

And not everyone patient or family seeks this human side, this empathetic affect from their caregiving team ... but I've grown as a nurse in the recent months and the more comfortable I become in my own skills and as a clinician, the more comfortable I feel being able to offer more than just competent safe care.

To the OP, I think you're fine. I do not become upset or sad at patients dying. It's nature. It's natural. As long you provide competence at the bedside with a good attitude, it's all about attitude.