Integrating Strong Emotions as a Developing Nurse

Most people, I would venture to say, start off in their profession with a fair degree of idealism, and this certainly holds true for nurses. When I talk with nursing students or new grad nurses and ask their story about why they chose nursing, the most common response runs along the lines of wanting to help others in meaningful ways.

Preparing new nurse grads for nursing realities.

In fact, I will meet with such a group of students this afternoon as I speak on a panel in the ethics class at my nursing alma mater. I, and other colleagues on this panel, want to encourage and inspire. But we will also be telling the students about the challenges we have encountered in situations involving moral distress, ethical dilemmas, and personal burnout. We will present situations when we felt that what we were doing at the bedside was not meaningful because we were only prolonging suffering—or, in other cases, so full of emotion and significance that it felt overwhelming to process.

We want to present the reality of nursing to these students, not to shatter their idealism, but to push them towards meaningful self-awareness from the start of their nursing career so that they are not caught off-guard by the degree to which they will be challenged on a very personal level by what nursing entails.

Even still, my colleagues and I realize that we can only impart so much to nursing students, as so much of the journey simply must be lived. I think about the new grad nurses I have precepted and how they enter a patient room in an end-of-life situation with a trepidation that may never fully dissipate, no matter how many times as nurses they find themselves in that situation.

Developing self-awareness about work-related emotions.

Perhaps what will help them most over time is an ability to be self-aware of strong work-related emotions, even grief, and a freedom as a growing nurse to work through these feelings with colleagues and loved ones. Such self-awareness will allow a nurse to accept and eventually integrate powerful emotions into his or her practice as a means to greater maturity.

In a TEDx Talk I gave in late September, I spoke openly of my experience of shaken idealism and the reality of work-related grief and trauma in nurses. I challenged myself, and other nurses, to stop thinking of strong feelings around patient suffering and death as something to be avoided in the interest of self-protection, but rather accepted and integrated as a teacher of resilience for nurses. My hope is that the talk will contribute to the broader ongoing conversation about the suffering we as nurses sometimes bear for others as we seek to help in the midst of challenging circumstances.


(For additional resources about the related issues of moral distress and burnout in nursing, see AJN’s Transforming Moral Distress into Moral Resilience in Nursing report and the ANA Professional Issues Panel on Moral Resilience report, Exploring Moral Resilience Toward a Culture of Ethical Practice. Also the recent blog post “Nurses Take Action on Moral Distress.“)


2018-01-18T10:04:09+00:00 December 8th, 2017|Nursing|2 Comments
Hui-Wen (Alina) Sato, MSN, MPH, RN, CCRN, is a pediatric intensive care nurse in Southern California and blogs at


  1. Alina Hui-wen Sato December 8, 2017 at 4:46 pm

    Wendie, I love what you shared here. I have a similar conversation as the one you described on a pretty regular basis as well, and I always find some curious comfort in hearing other even more experienced nurses than me in my unit tell me that they still feel nervous, and/or that they still wrestle with grief over our patients even after 15-20+ years. It gives me hope that we are not all destined to become hardened in heart out of self-preservation, and we can all continue to hold a certain degree of reverence, if that is the right word to use, for the work that we do.

  2. Wendie Howland MN RN-BC CRRN CCM CNLCP LNCC December 8, 2017 at 12:30 pm

    Many years ago I had been working in a world-class CVICU for a few years and was doing well, as far as I could tell. One morning I was in the report room with Sarah, a very experienced ICU nurse who could do just about everything, and for whom I –everyone, really– had tremendous respect. “When do I stop feeling nervous” I asked her.
    “You know, I still feel a little nervous just before report,” she said, “Every day. A little bit of nervous isn’t bad; it makes you alert. I don’t worry, because I feel prepared and I know I have backup and help if I need it. But if I ever stop feeling that little edge of nervousness, it might mean that I could be getting careless, and I would have to work somewhere else.”
    I have thought of that often when in challenging situations, and told students that when I sense they despair of every being “like a real nurse” (which is pretty much every time I work with them).
    Nervousness gets your endogenous catecholamines flowing, which kicks some glucose out of liver storage to make your muscles and brain work better, causes your eyes to increase their acuity, decreases your reaction time, increases your blood pressure to support increased activity, all things you are unaware of but that make you prepared to face a challenge. You’re more ready than you know, I tell them, you care, and you are never alone.

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