The Slow Burn

If I had a dollar for a every time someone said something along the lines of “I don’t know how you can do what you do”, I would have a serious pile of cash. Seriously, the truth is some days, I don’t know how I do what I do. It is physically, mentally and emotionally exhausting. Whenever I am giving advice to caregivers, my go to phrase is “Take care of yourself because you can’t draw water from an empty well.” What about our well? What happens when it runs dry?

There are a few unavoidables when you are a hospice nurse. You will deal with death, grief, frustration, sadness and loss. There is no guidebook that could ever efficiently prepare one for this job. Nursing, in general, is an occupation that can burn one out. If most areas of nursing are like mountains to climb, hospice is the Everest. When other nurses tell you they could never do your job, it is pretty fair to garner that hospice nursing isn’t for the weak.

But, as strong as we hospice nurses are, we are, at the end of the day, human, too. The emotional symphony that we experience everyday isn’t without its cost. Studies show that hospice nurses typically burn out within the first year. Why? That’s easy.. compassion fatigue.

There are families and patients we cannot help but get attached to. Something about the situation awakens a part of us that makes the boundaries we typically put up, become an impossibility. It becomes so easy to just slide into the different member’s roles and live their emotions. The searing pain of loss, the palpable and terrifying fear of the unknown, the frustration over the always asked “Why?” We begin to start to carry the burdens of others without regard to our own. When the caregiver’s caregiver has an empty well, what happens?

Hospice workers are often seen as superheroes. Our work involves an area that most fear. But, at the end of the day, we are human- we feel.. we think.. we hurt. The problem that then begins to form is compassion fatigue.

The easiest way to explain it is that it is an almost PTSD like in the feelings it brings. Nightmares, reliving of specific moments, the haunting, the birth of decreased empathy and culmination in not wanting to do this emotionally tumultuous job anymore.

It really is a calling. Ask any hospice nurse and they will gladly tell you that this is more than a job. We have all done the 12 hour jobs in the hospital that allow for the end of a shift pass off of patients. That’s not the case here. Being in hospice has to be felt with fervor in one’s soul because it really does engulf you and your life.

Nurses are the worst at putting ourselves first. Hospice nurses are the creme de la creme. We preach the gospel of self care yet we fail to do so. Those who can’t, teach. The signs of fatigue start insidiously, but then multiply like mogwi with water. Feeling them, however, is normal. It’s fighting them or ignoring their existence that then cause the vicious cycle to begin and perpetuate.

Do you feel yourself getting angry with a family who doesn’t follow recommendations? Do you feel guilty at the end of a day when you aren’t carrying your work phone around? Do you feel that no one, no matter how qualified, can take care of your patients like you? Do you relive those difficult deaths over and over wondering what you could have done differently? Are you having trouble sleeping? Nightmares? Headaches? Nausea? Finding yourself calling off because you just can’t do it today? Is there this sense of dread that creeps over you like a fog?

Since this is my blog and since I feel I can be totally honest, I have suffered from compassion fatigue. I have gone to visit a patient thinking that I really had nothing left to give. I have woken up some mornings thinking I couldn’t do this. The anger. The hurt. The frustration. All of those emotions, like individual spices that melded to form the perfect recipe for compassion fatigue.

We don’t like to talk about it. We are superheroes, remember. Goodness gracious if we show we are just regular humans with feelings, how will we ever be able to be thought of as the dragon slayers of death? But, the truth is, we are. Just like David, we are mortals, who face the Goliath of death yet feel the cascade of emotions we are thought of not to feel.

The first step is being honest. It is ok and normal to feel these feelings. We aren’t expected to be devoid emotions. But, unless they are expressed, they cannot be helped. Keeping them in creates an emotional pressure keg which ultimately leads to an explosion which causes great nurses to leave hospice.

This is so much easier said than done, but, take time for you. Step away from your phone and laptop. Create a separation between home and work and respect that. Find a nurse buddy that you can be transparent with. Play with your dogs. Go to therapy. Workout. Journal. Whatever it is that makes your soul happy, do that.

Guilt sometimes makes doing all of these things an impossibility. How can I be happy and have fun when my patients and families are suffering? Simply put, it is essential because if we allow ourselves to be pulled into downward spiral, we cannot be the most effective versions of ourselves. The version that they need. The version that they deserve.

Those who love me will attest to my being a work in progress for these things. I tend to want to be everything for everyone, as is a common trait amoung hospice nurses. But, I sometimes (ok, maybe more than sometimes) forget to be everything for me. Opening up is my way of facing compassion fatigue head on. What will be yours?

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4 thoughts on “The Slow Burn

  1. Thank you for sharing your own struggles. I am not a nurse yet(I start school next year) but I am a certified hospice aide and I am definitely suffering from most of the things in this article. I have an ALS pt that has some very difficult family dynamics that has really caused a lot of compassion fatigue for me. I have had her as a pt for over a year and a half…her breathing is below 20% so her time is near…I see her 5xs wk…I am the only aide she will accept and she does not accept any other disciplines besides the CM and LVNs. I am seeking self care. I see a thg therapist 1xwk, bike ride on my days off with my family, joined the hospice support group, and keep my work phone off on my days off. This week 8 of my Angel’s went home. I’m happy they are at peace but I find myself sad this weekend wondering who will be left for me to care for this week. 3 years of this…I’m feeling I need a break.
    Thank you for your insight and thank you for validating my own humanness.

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    1. ALS is so hard. One of my toughest patients was an ALS patient. It was so emotional because she wasn’t much older than me. Broke my heart.
      This is something that remains unspoken. It is almost taboo to talk about. But, it happens and very often. We must take care of each other so that we can care for our patients and families.
      Whenever you need to talk, please feel free

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  2. This touches home. I have been a Hospice RN for almost 13 years. Feel it is a calling that I am blessed to be a part of until recently. Anxious, tearful, and nauseous before my 13+ hr ( three 12’s in a row) at an in-Patient Hospice House frequently. Exhausted and playing catch-up until I am scheduled to do it again…

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    1. I know exactly what you mean. We, as nurses, have such a difficult burden. We carry so many people’s emotional troubles and yet most forget we have our own. Sending you love and strength. Take a deep breath, close your eyes and think about all of the souls you have helped.

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