In a recent harrowing shift and the subsequent “I feel like I’ve been hit by a truck” day after, I found myself wondering what was really behind some feelings in me that we generally label “burnout.” Did I just not care enough about my patient and her family to consider all the hard work more than worth it? I adored them, and was willing to do the hard work it entails to take down and restart the complex, specialized dialysis system my patient depended on.

Yet, I found my entire being so drained, and wondered what had become of my heart. Did I just lack sufficient empathy to fuel an endless “let’s go!” attitude?

I wasn’t necessarily worn down by lack of desire to help my patients have as healthy and lengthy a future as possible.

I was worn down by the unexpected hiccups in technology that set me back significantly and multiplied my workload, when I’d otherwise tended to every detail to make complicated processes go as smoothly as possible.

I was worn down by the mental gymnastics and overload of being the coordinating hub for every service, every changing piece of patient care, every side conversation, every distraction that made it so difficult to focus and keep track of each crucial detail in my patient’s complex care.

I was worn down by feeling like saran wrap when it’s stretched and barely holding together to try and cover all the space it needs to cover without breakage or holes, as I heard all the commotion in our unit and had to relinquish our resource nurse from my room to tend to a more pressing crisis.

I love my unit, mind you. I love my colleagues in all disciplines. We have a wonderful team. But healthcare is a beast, particularly in current times when political chaos has led to unprecedented challenges for hospitals all over the country.

When I was a young nurse, I thought my core empathy and benevolent desire to help people, my sense of ‘calling,’ would be enough to fuel my nursing practice.

But if I’m brutally honest, sometimes it’s desperation and obligation. I think of healthcare workers in war-torn countries, working in dangerous environments with minimal resources. They undoubtedly have deep wells of empathy for their patients. But I also imagine they are also fueled out of sheer desperation and obligation to the crisis in front of them. 

Sometimes, part of what keeps me around is professionalism and needing a job. If I walked out mid-shift because I was feeling highly stressed, not only is this wildly unprofessional, I’d be soon out of a job. 

Sometimes it’s pride. Sometimes it’s just not wanting to crumble entirely in front of my esteemed coworkers. For better or for worse, their opinion of me is part of what makes me want to do a good job as a nurse.

Sometimes it’s sheer grit. Tomorrow, I tell myself, I can rest, so I’ll grit my teeth through the rest of this shift.

As I write this, I am tempted to shame myself for saying these honest things out loud. But actually, this all only makes sense, particularly for this kind of work. I probably should feel some degree of obligation to these highly vulnerable patients and families. I should have an internal professional code of conduct. I should care whether I’m pulling my weight in this team. I should have a sense of self-respect.

I also maintain, with a growing number of voices, that we nurses need external things to serve as ongoing fuel to sustain our core empathy and desire to serve others.

We need a healthy work environment. Civility, sufficient staffing, fair pay, and high quality supplies.

We need a political environment that is not threatening to cut off healthcare coverage and funding for these precious humans we care for daily, feeding a growing unease and rage over the knowledge that these lives will pay the ultimate price of suffering and agony because they cannot receive the lifesaving care I and my colleagues are working so hard to provide.

I refuse to gaslight myself and my colleagues when we sometimes question if we are losing our heart for our profession. It’s not at all that we don’t care about these patients. It may be BECAUSE we care, that all these other components need vital attention.