On the surface, when nurses first start out in our career, we have a vague and admittedly idealized sense of how compassion will always be a core driver in why and how we care for our patients.

But we quickly discover that navigating our emotions over our work is fraught with complexity and mixed messages, from outside as well as from within.

You should care…

“Don’t let your heart become too hard or you shouldn’t really be in nursing any more.” 

“Compassion should always be present in our interactions with patients and families.” 

“I feel worried because I used to care a lot about my patients, and now I just feel apathetic.”

…but don’t care too much. 

“You can’t let yourself feel too much for your patients or it will overwhelm you.”

“I don’t let myself go there. It’s a job. I come to do my work and then I go live my life.”

“I’ve been crying so much over our patients recently and this makes me wonder if I’m cut out to do this job any more.”

It’d be nice if emotions in healthcare could be prescribed and titrated to therapeutic effect, like norepinephrine infusions to maintain a particular blood pressure. “Care just enough so that you can be moved, and maybe shed a few tears but not a river. In any case, always put yourself first at the end of the day, so you can clock out and still be “well”.”   

Certainly, living in sustained emotional extremes raises some questions worth looking into. “Why have I stopped feeling anything at all?” or “Why am I completely immobilized by my emotions?” 

But outside of the extremes, I can’t help but wonder if we are asking the wrong question, when we ask “How much emotion in nursing is too much?” It assumes there is always a right answer regardless of so many dynamic variables. “Oops, I didn’t stay stoic, and I did more than just tear up a little today! I cried pretty hard in the bathroom. Did I cross the line?” It assumes we can not only pinpoint the right amount, but also define and control its “right” expression. 

What is tricky is that we are unique individuals, with unique backgrounds, personality types, capacities at various stages in life, coming into contact with any mix of unique patients and family units at any point in time.

We’re human. Sometimes, we just form connections and we are moved by certain patients and families. Sometimes, our patients are so extraordinary to us, they deserve for us to grieve for them deeply. And sometimes, our hearts are so extraordinary in the work they’ve been doing, that they deserve time to have respite from all of our emotional labor. 

Perhaps a different starting point is one in which we assume that highs and lows of emotional engagement will inevitably come over time, with different cases and different seasons. Often, they will be unpredictable. Rather than shaming or harshly judging our highs and lows, perhaps we just need to anticipate them, and become more familiar with ourselves, our limits, our sources of support, and the systems within which we work, to know how to navigate them.

And, perhaps we need to also learn how to look at strong emotional expression as a healthy way of coping with our work, rather than a sign we are ‘not handling things well.’ 

Ironically, I find myself tempted, even still, to try and type out some kind of prescription for managing our emotional life as nurses at a perpetual steady state. I want this just as much as anyone else.

Instead, I’ll end with a personal story to simply illustrate what I’m getting at.

There was a trauma patient in our unit awhile back whose story was devastating. It was the kind of freak accident that makes everyone ache as soon as you hear it. I had wild clinical shifts trying to stabilize him in the beginning. I sat in intensely emotional family conferences with physicians delivering hard news to the parents. Somewhere in there, I built a connection with the mom that few people were able to establish because she’d been so closed off. 

I had a gut feeling that this patient and family would benefit from me signing up to be a primary nurse for them. 

I knew my personality type. I’m an empath and feeler, through and through. I was already carrying a lot of emotional heaviness from my shifts with this case thus far, and I knew that if I signed up to primary this patient over months, I would have to count the costs of the emotional, social, and spiritual work this would entail. It was important for me to know my baseline in how I tend to function, emotionally.

I knew my core values. I deeply value genuine connection, and would prefer at the end of the day to veer towards caring too much, versus caring too little. This isn’t to say that I don’t have boundaries, or that I have to do this with every single patient in our unit. It is to say that in voluntarily signing up to get in deep with this very hard case, I had to be value-driven so that I could keep going when it felt especially hard. 

I knew my current system of coping and processing was healthy enough that I could sign up for this. I had wonderful sources of emotional support, between my husband, incredible coworkers, close friends, and my therapist. I knew I would be putting a personal retreat for myself on the calendar in the near future. I knew that God heard all my laments, questions, pleas, and frustrations. My faith informed my ability to find hope and comfort even in the midst of tremendous mystery and agonizing pain for this patient and family. It wasn’t that I felt perpetually stable by any means, but I had enough foundation under me and enough support around me to hold me up when this case shook me the most. 

I knew I was in a season of life where I had the emotional capacity to sign up for being a primary nurse for this patient. Unlike the COVID years when I was overwhelmed with managing online learning for my young children at home, or the year of multiple health crises for me and my husband, this patient case met me at a time when home life had normalized. My own personal cup was full enough that I could pour out more for this patient and family.  

And pouring out is what it was. I poured out tears. I poured out energy in hours-long conversations with the mom. I poured out a lot of time processing how this case impacted me, long after the patient transferred out of our ICU. I didn’t sign up to primary anyone for a while afterwards. I spent a lot of personal time taking care of myself in the aftermath. And I never once regretted signing up to walk closely with this patient and family. 

There are highs and lows and everything in between with patient cases. Our emotions will ride those waves as well. We may serve ourselves and each other better by removing the “too much” language from the way we assess our emotions, as if we are somehow failing by crossing an imaginary line we’ve drawn with our minds. Perhaps simply holding more self-awareness with curiosity and permission for being human, in the context of a supportive village, may be a healthier starting point for us in navigating the inevitable ups and downs.