1. Taylor, Elizabeth Johnston

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"Our nurses had a ratio of 1:7, sometimes 1:8; being unable to physically or mentally care for my nurses and my own patients broke me." "I've lost my passion for nursing." So wrote nurses in response to a survey about the effects of COVID caring (unpublished data). Many nurses have burnout, a phenomenon that includes being emotionally exhausted and depersonalizing the people for whom one is supposed to care. Yet empathy is key to caring, the essence of nursing. The question arises: How can a burned-out nurse continue to be empathic, to care?

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Clinician empathy is a "predominantly cognitive (as opposed to emotional) attribute that involves understanding (rather than feeling) the patient's pain, suffering, experiences, and concerns" (Hojat & Gonnella, 2017, p. 743). The findings from many studies, usually investigating physician empathy, document positive outcomes of clinician empathy that include patients' increased trust in the clinician, compliance with prescribed treatments, immune function, and various other beneficial patient outcomes (Hojat & Gonnella, 2017; Weilenmann et al., 2018). Thus, expressing empathy not only characterizes a compassionate healer, but also a clinician who is effective in promoting physical, psychosocial, and spiritual health for patients.


Given the moral imperative to provide empathy as well as the rampant burnout that makes it difficult, the following suggestions are offered:


* Remember clinician empathy is primarily a cognitive process. It is something you can choose. For example, when you are with a patient you intellectually know is suffering and you feel disengaged or irritated, notice and accept it. Happy, warm feelings are not requisite to professional caring. Biblical admonitions advise us to love with actions, not necessarily feelings (1 John 3:18).


* Do not harbor shame or guilt when you cannot feel emotionally responsive to patients. Rather, affirm yourself for noticing and mentally choosing to help anyway. Honor who you are in the moment. Honor even the darkness within and your limitations (e.g., "I'm doing my best, given circumstances"). Although God eagerly receives all gifts of love, could it be that nurses who choose to provide care despite their emotional exhaustion are offering up the greater gift, compared with those who practice it without challenge?


* Walk only a mile in another's shoes. Cognitive empathy entails perspective-taking. Ask yourself, "What is this patient thinking, seeing, experiencing?" Even if you cannot mirror their feelings, you can apply communication skills to recognize their perspective, listen to allow them to gain insight by talking, and coordinate nursing care for them. Walk only a mile, however; that is, maintain boundaries. Indeed, overidentification with another's suffering will undermine your ability to help (Weilenmann et al., 2018). Remember, Jesus did not heal everyone.


* Balance emotional involvement with detachment; that is, regulate your emotions (Weilenmann et al., 2018). Ways psychiatrists reported reestablishing the balance they needed while working with patients included doing something intentionally to refocus awareness on themselves (e.g., deep breath, repositioning, getting water), and symbolically placing space between themselves and a patient (e.g., imagining more space or a physical boundary between). Finding social support-venting with safe colleagues, friends, or a counselor-also were helpful in understanding and balancing their emotions. Indeed, we all must take care of our emotional needs first so that we can care for others' needs.



These suggestions are not a quick fix; rather, they may be drops in a bucket that refills over time.


For the nurse who is disengaged, emotionally exhausted, and has lost passion for nursing, this brokenness brings a deeper sense of powerlessness and not-being-God. But there is a season for everything (Ecclesiastes 3). This winter-like season of barrenness may actually be dormancy: From brokenness can spring an awareness that one's works are actually "accomplished by God" (John 3:21, CSB).


Hojat M., Gonnella J. S. (2017). What matters more about the Interpersonal Reactivity Index and the Jefferson Scale of Empathy? Their underlying constructs or their relationships with pertinent measures of clinical competence and patient outcomes? Academic Medicine, 92(6), 743-745.[Context Link]


Weilenmann S., Schnyder U., Parkinson B., Corda C., von Kanel R., Pfaltz M. C. (2018). Emotion transfer, emotion regulation, and empathy-related processes in physician-patient interactions and their association with physician well-being: A theoretical model. Frontiers in Psychiatry, 9, 389.[Context Link]