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.“)