The Feels

I recently received an email from a soon-to-be nursing student who expressed concern about the potential emotional response she might have in the clinical setting, based on her past family experience with illness. It was a great question, one that I’ve been mulling over during these past eight weeks of clinical time on both medical and surgical oncology floors. I thought I’d share my reply, as it ended up being a great opportunity to reflect on what I’ve learned so far in my own journey as a nursing student.

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I totally hear your concerns…I think the part of nursing that draws most of us in–the art of compassionate care, can also be the part that wears us down the most, especially if we don’t have good self-care practices in place. There’s definitely lots of literature in the nursing world about compassion fatigue, and I guarantee you’ll see it as a student. It’s something you’ll need to be prepared for…but I also think that with mindful practice, it can be avoided, or at least minimized.

I think the biggest first step to protecting your ability to engage in this work for the long haul is self-awareness…and you already demonstrate this by asking the question and knowing your own background and triggers. I think it’s smart to start taking stock of your resources now: how do you cope with stress or sadness or fatigue? what feeds you? what are the coping habits that you find most helpful, and what are the ones that come up that are maybe not so helpful? what do you think might be helpful to explore or change about your coping strategies, and who might support you in that process?

I started reaching out before I started classes…I had friends who had been through the program who found a lot of value in either establishing or reconnecting in some kind of therapeutic relationship. I’ve found counseling to be helpful in the past and so I made the decision that I wanted to work with a counselor for a while as I started the program…it offered me a space to reflect on my journey, do some goal-setting, and also to talk about anything that came up for me as I delved into being a complete novice in a new field. I don’t think everyone needs a counselor or would necessarily find benefit in it, but I found it incredibly helpful, so I’ll throw that out there as an option to consider.

Beyond that, one thing that is reinforced a lot from day one is that nursing is not about us. It’s about the patient. That means that we sometimes need to check ourselves and consider what is going to be most helpful for the patient. Perhaps it sounds a bit harsh now, but over the past year, I’ve really come to view that sentiment as a help rather than a hindrance. It gives me the freedom, as well as the responsibility, to set good boundaries for myself. I know that in order to sustain my capacity to be in a caring profession for the long-haul, I can’t become invested in my patient’s lives the way I might if I were their friend or relative or neighbor.

But.

It would be preposterous to say that I never become emotional…the “feels” are real and are what allow us to connect, one human to another. That’s also an essential foundation of the nurse-patient relationship. So…you know, sometimes, I think it’s appropriate to cry with my patients. I always have in the back of my mind, though, how it might affect them. And if I’m worried that my own emotional response might be a burden on them rather than a source of connection, then I might find a way to step out of the room for a moment, if possible.

Truth be told, even being on an oncology unit, I have not yet found myself in a situation where I had to step out. Part of that is me being pretty good and holding things together in most circumstances, part of it is also being really focused on the technical aspects of my care and hands-on skill. It’s hard to feel super emotional with a patient when I’m focused on not breaking my sterile field as I’m inserting a Foley catheter! I think the few times I’ve found myself getting “emotional,” it’s felt ok to me and to my ability to care for my patient to show that emotion.

An example: I was working with a patient who was approaching transition to hospice care. At the hospital where I was doing my clinical, they employ music thanatologists, professional musicians (usually trained in harp and voice) who are trained to provide music vigils for patients, their families and the health care staff. They’re incredible–you can read more about their work here and here.

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photo from The Oregonian, 2009

So, this lovely musician came in to play for my patient, who was a musician himself. She introduced herself, asked a bit about his story and his illness. She then took his pulse, literally touching his energy and connecting with his heart rhythm. And then she sat down and played, for the next twenty minutes or so. Music thanatologists specifically avoid songs with lyrics…but will often play pieces that evoke emotional response.

I asked the patient if he wanted me to stay in the room with him and he said yes. So, it was the three of us together just enjoying the simple beauty of harp and voice. Time seemed to stop…we could forget we were in a hospital for a brief while and just be together. I found myself deeply moved at how such a simple gesture–the act of giving and receiving the art of music–could bring such joy and peace to someone who knew he was nearing the end of his life. I was so grateful to be able to share in such an intimate moment and I found myself tearing up…this patient reminded me a lot of an older beloved relative of my own who had passed in the last year. The intimacy of this moment struck something deep after a morning of running around being most concerned with the technical aspects of nursing.

I guess I share this story with the hopes that you will not feel scared about the potential of your “feels” emerging in your practice as a nurse and midwife. It’s true, you can’t let them get in the way of you being able to offer the care your patient needs…but they are also what allow you to connect with your patient. They know when their nurse is detached–the difference is palpable–and that detachment can be an obstacle, too. So, it’s all in the balance, which is why I’ll conclude again with self-care. It’s so, so important.

It may be tempting in these last weeks before school starts to get caught up in the whirlwind energy of preparations, but as much as possible, I’d encourage you (and anyone starting school soon) to sloooooow down as much as possible. Sleep. Eat good food. Take long walks, alone and with friends. Reconnect with the practices and people that nourish you, because you’re about to start a wild ride that will go really, really fast.

(This next paragraph is more specific to our program, which doesn’t require a particular sequence or breadth of clinical rotations…it may not be true for every nursing program.)

I hope that really long-winded response is helpful! Also know that you don’t have to do oncology as a clinical placement. It’s one option of several you’ll have for both the acute and chronic terms…and some people will just decide that it’s too much and opt for other more general placements. I wanted to do it because I felt it was a realm of nursing that closely paralleled many aspects of the midwifery model of care. I think that feeling comfortable with the end of life is, in many ways, important for midwives. Traditionally midwives attended to their communities at both birth and death. There’s something about both of those periods of transition that I really resonate with and I felt that time on the oncology floor would benefit my practice as a midwife…but again, you’ll have lots of options!

What words of wisdom would you share about the art of holding space for emotions that arise in nursing care? What self-care strategies work for you? Share them here, on my Facebook Page or on Twitter (@radmidwife). I’d love to compile a list!

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