I was talking with a dear friend who was telling me how she went through a period when she had wondered whether nursing was destroying her. I can’t say what she actually meant by this for her own self, but the comment stood out to me. I found myself chewing on this notion that we can feel slowly worn down by the overall experience of nursing to a point where we feel the losses are not being offset by the gains quickly enough.

A certain loss of innocence.

Given all of the random tragedy, self-sabotage, and violence that nurses may witness in their patients’ stories, nurses can experience the loss of a more innocent, optimistic perspective about people and the world. Nurses often say there are things you cannot “un-see” in this line of work. Those experiences can darken the lens through which we see the world. The loss of faith in the assured wellness in the world can feel disheartening. It can be difficult to know how to process this in a way that does not simply leave us more fearful or cynical people.

The energy drain.

On a less philosophical level, it is no new revelation that nurses give intensely of their physical, mental, and emotional energy, but do not feel it is easily replenished. Why does one full day off not always rejuvenate us and balance us out after a challenging 12-hour shift? The demands of one shift are so multilayered and exponential, the math simply doesn’t always add up and we can be left feeling frustrated at the ongoing feeling of exhaustion.

It may seem as though we are simply carried along an inevitable course towards feeling perpetually tired, jaded, and a bit traumatized.

Real gains—but harder fought and often hidden.

What is not always readily obvious is that the gains to be had from nursing often have to be slowly—and intentionally—built up. Of course, there are some gains that are simply a gift—the privilege to see patients recover (sometimes miraculously), the words of gratitude from patients and their families, the appreciation and trust from the general public. But these gains or positives, while important, may at times feel insufficient to replenish us.

The importance of reflection, perseverance, acceptance.

The deeper gains that develop greater internal fortitude are ones that require reflection, wrestling, and also some acceptance of those things that cannot be fully fixed or explained. This can be difficult if we feel we lack the energy to take on this admittedly difficult process of inner growth. Nonetheless, the gains exist and are worth the effort. The challenge for the nurse is to enter into the process and embrace it with patience.

Gains in strength and self-knowledge.

There are gains of rediscovering and redefining a hope that encompasses but also transcends particular circumstances. There are gains of digging deep to decide for ourselves how much we are willing to sacrifice for others, particularly those we don’t feel “deserve” our help. There are gains of learning our own self-respect and self-care rhythms; even as we learn to sacrifice, we also learn to strengthen our own boundaries and validate our own limitations.

Understanding the bigger picture helps.

Understanding the trajectories of these dynamics may also help us. Unless a person has already developed some of these inner resources through life experience prior to becoming a nurse, it is quite possible to initially feel more of the losses than the gains in the first few years of nursing. It is like a young apple tree that had its first harvest quickly plucked off its branches by a hungry crowd. The losses will be the more acute experience, but the gains will be like roots growing slowly underground. The benefits may not be evident until future times of harvest, when the tree has grown stronger and can feed larger crowds, but only after giving up its first harvest and enduring its first long winter or two.