I keenly remember how I answered the question of “things I can work on” during my first annual evaluation as a new nurse. I was perhaps six months into my employment in the emergency department and had not yet experienced the throes of true mental exhaustion and burnout. Yet I had begun to feel a tug at my heart, the little moments of frustration at patients, the feeling that maybe I could care a little more. When asked during my evaluation, I answered matter-of-factly that I wanted to remain empathetic and compassionate and try to prevent professional burnout.
With a few more years of experience behind me now, I feel as if I’m standing at the edge of a giant canyon and my younger, inexperienced self is on the other side. We are staring into the same chasm and both understand what we are beholding, yet my younger self has not gotten close enough to the edge to fully see its depths or the darkness within. And indeed that is how I would now express my experience with burnout — as a great nothingness that fills in the space where empathy passion, interest, and ambition once dwelt. After attempting to resuscitate a crashing patient and being unable to do so, I would try to will myself into feeling emotion. I would tell myself that this was someone’s grandmother, grandfather, son, or daughter. I would imagine my own loved one in that same stretcher for a moment before rushing to the next patient needing my care. The chasm would open a little wider.
I am convinced that professional burnout in medicine is a multifaceted issue with many contributing factors, and I hesitate when I see “burnout programs” or read articles that advocate for doing a little more yoga or taking more vacation time. While I agree that striving for work-life balance and taking time away from work can improve the symptoms of burnout, it does not address the root cause. I believe that reversing the cycle of burnout would require a large shift in the culture of health care as a whole, which is entirely too much to discuss in this article. What I instead desire to share is how I found my way back to genuine connection with patients and meaning in my work.
I often find myself craving stillness and beauty, to look up into the expanse of a starry evening sky and feel its greatness. I’ve discovered that sometimes a distant constellation catches my eye only when I am not looking at it fully. It has always been there, yet is incomprehensible when I attempt to behold it directly. I too reached for compassion, grasped at it, willing myself to believe that it was still within me. The more I looked, the harder it was to find.
I began a little exercise of trying to learn something interesting or personal about my patients that I could connect with. I would talk with them about their pets while starting an IV, laugh with them about a TV show while documenting, or listen to them talk about their family. While time is constrained in the emergency department and there is always another patient to care for, I try to maximize the time that I am given with each one. Simply connecting with and acknowledging the humanity and individuality of each patient makes an encounter into an interaction. Human interaction was what drew me to medicine in the first place, and it is what brought me back.
In the emergency room, I care for a diverse population and interact with a variety of patients from various backgrounds and situations. Forging a connection with patients who I found challenging to interact with taught me how to overcome barriers to empathy and to find common ground. I learned that engaging in experiences that create meaning through connection is invaluable, whether it is through taking time to learn the names of a patient’s grandchildren or listening to them pick a tune on their worn-out guitar. These experiences continue to renew my commitment to the values that are integral in medicine and make me grateful to have chosen this field.
Christina Wornom is a registered nurse at Spartanburg Medical Center's Emergency Department and has worked there for three years. She serves on several committees including a Core Measures Process Improvement Team and is passionate about improving the quality of care provided to patients. Christina is currently in the process of seeking admission to medical school. She has no conflicts of interest to disclose.
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