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While trying to catch up with my professional journal reading, I came across a new term-vicarious traumatization.1 Thoughts and feelings that I've had for years suddenly had a name and, at last, validation!!

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In the article, nurse-author Barbara Cosentino discussed Charles R. Figley's work on post-traumatic stress disorder. Figley identified a syndrome called compassion fatigue, a type of burnout experienced by caregivers. Symptoms include feeling filled up, overwhelmed and wrung out from all the suffering. Although the caregivers were not physically suffering, they became infected by the trauma experienced by those in their care. Nurses who experience compassion fatigue may experience vulnerability and fragility, awakening old memories and reactivating pain and sadness about previous losses or traumas experienced in their lives.


My professional nursing career has spanned thirty years of working with chronically ill children diagnosed with cancer, hemophilia, sickle cell disease, muscular dystrophy and cerebral palsy. Most of these children have died. All too often, I've gone home to my family feeling that I didn't have another ounce of energy to give them, because I already felt used up. No matter how hard I worked and prayed, the grief and unanswered questions never seemed to end. How can I answer the Why? voiced out of a parent's sorrow, when I can't answer my own Why?


How can I comfort a grandmother, grieving for her own child and her grandchild? I don't have enough words to soothe an angry father who needs to stay at the hospital with his family but has to go to work so his insurance coverage won't lapse. I watch helplessly as a child, considered cured of cancer, dies from a secondary malignancy caused by the initial cancer treatment. How can I foster hope in a teenager, severely affected with cerebral palsy, who tried to commit suicide by steering his motorized wheelchair into rush hour traffic? A war wages in my spirit.


I love nursing and can't imagine leaving the profession, but I realize that I can't go on with my heart being ripped to shreds on a regular basis. I tried to reconcile the pain and injustice by rationalizing that everything possible was done, but that didn't work. To make things worse, my hospital met the never-ending chorus of patients' needs with budget cuts, resulting in short staffing, leaving fewer people to do what needed to be done. Forget TLC; often there weren't enough hands just to do the basics.


The dichotomy I experienced pitted the professional nurse's role to provide therapeutic care and foster hope against the reality of feeling that nothing I did was ever done well. There weren't enough hours in the day to do a thorough job. Feeling drained of energy by the end of the day, with nothing left for my family or myself, merely perpetuated the frustration.


When my nursing career began, women had three career choices-nursing, teaching or homemaking. I chose nursing. My role models were women who were effective, efficient and kind. I felt I had a mission too-to become an expert clinician, cheerleader and solver of all problems-also known as Super Nurse. In those days, we believed that if we worked hard enough and wanted it enough, our patients would beat the odds and be restored. However, in reality, education, skill, fervor and meticulous adherence to treatment regimens did not guarantee success.


Patients and families trusted us to help them through difficult, intimate times in their lives. A patient's death became a personal failure. Immaturity and idealism made it impossible to understand that the standard of care I was trying to achieve was unattainable. Over the years, I became mentally exhausted and physically sick. It was time for me to stop the litany of should-a, could-a, would-a.


In my search for answers, I found an article about a theoretical framework called the Serenity Scale.2 For some, serenity is a New Age concept, but it is also important for Christians. According to recent research, "Serenity involves the practice of vibrant processes that lead to spiritual well-ness. The processes of acceptance, forgiveness, meditation and prayer all seem to be a reciprocal relationship between acceptance and forgiveness of others and experiencing serenity for oneself."3 I've always prayed and tried to rely on God for help, but, intellectually, the concept of let go and let God was unfathomable to me.


After years of searching, I've tried to formulate an answer that's right for me and my family. First, God must be my source of strength and energy-not chocolate, shopping, food or incessant busyness. Second, suffering is universal in a sinful world, and for me to be therapeutic, I must accept that premise, no matter how unjust the situation seems. I must remember that I cannot fix everything because I'm not the answer to everyone's problems; God is. Third, I can serve as a channel for God's grace by being a tangible conduit that can touch, laugh or cry with his children in their suffering, but I have to work wisely because I am human too.


Sometimes it's difficult to remember that God's intention for wholeness and healing may not coincide with my definition. Once I've asked God for help, I need to make a conscious decision to relinquish my need to interfere with the process, even if it means saying a hundred times a day, "I trust You, Lord, to care for this situation in the best way possible."


I've learned to step back and take time to assess the variables in a situation instead of acting first and asking questions later. I do not need to volunteer to meet every need. Excessive busyness simply prevents me from dealing with issues I need to resolve. The important things will get done, even though I may not be the one who does them. I'm learning to pace myself and exercise regularly, and to set aside time for prayer and meditation so that I can empower others, as God wills, while employing wisdom to protect my heart and energy level-most of the time, anyway!!


The Serenity Prayer by Reinhold Niebuhr, which was popularized by Alcoholics Anonymous, apparently had it right all along. I pray, God grant me the serenity to accept the things I cannot change, to change the things I can, and the wisdom to know the difference.4 I can trust God to give me the grace to do my part, and I can also trust him to prepare others who will do what I cannot do to help those who are hurting.


The Serenity Prayer


God, grant me the serenity to accept the things I cannot change,


The courage to change the things I can,


And the wisdom to know the difference.


Living one day at a time,


Enjoying one moment at a time,


Accepting hardship as a pathway to peace,


Taking this sinful world as it is,


Not as I would have it.


Trusting that you will make all things right if I surrender to your will,


So that I may be reasonably happy in this life


And supremely happy with you forever in the next.




Reinhold Neibuhr-public domain: accessed from


1 Barbara Williams Cosentino, "When Helping Hurts: Vicarious Traumatization," Nursing Spectrum 13, no. 1 (2000), 14-15. [Context Link]


2 K. T. Roberts and A. Whall, "Serenity as a Goal for Nursing Practice," Image: Journal of Nursing Scholarship 28, no. 4 (1996), 359-63. [Context Link]


3 Gerard J. Connors, Radka T. Toscova and J. Scott Tonigan, "Serenity," Research in Brief, January/February 2000, Research Institute on Additions, accessed at[Context Link]


4 Common domain. [Context Link]