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How I Stepped Back Instead of Stepping In During COVID-19

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I got the call in early April — the call I had been waiting for. 

My credentialing had finally been approved and my employer asked, “Can you start tomorrow?”


I checked in with myself.

Head: Finally! You’ve been preparing your whole career for this moment.

Heart: Absolutely not, are you willing to give up your whole life for this moment?

It was April 2020 and after taking nine months off with a new baby and moving to the New York City area from upstate, I was getting ready to start my new per diem job as an emergency NP.

I had signed my offer and submitted my paperwork in January, with the exciting expectation of working one shift per week to stay clinically fresh, while the rest of my time could be focused on caring for my three young children and nurturing a career as a mentor for NPs. 

In early March, the world around me slowed down and paused, as my EM colleagues geared up for the pinnacle moment — the one that would define their lifetimes. 

I knew that I would get the call, but secretly hoped it would never come. When it did, I was paralyzed with indecision.

Realistically speaking, school and daycare had been canceled and my husband was still working his executive job from home. There was no one to watch my children while I went to work, nor could I safely distance from my family.

When I checked in with what I actually wanted to do, I realized I didn’t want to go to work. I didn’t have to go to work. And acknowledging that is what started the guilt, shame, and self-bullying.

Head: This is what you signed up for! You would be abandoning your colleagues. It’s your duty to step up in worst-case scenarios.

Heart: You don’t need this job. Your family needs you healthy and alive.

This was the worst cognitive dissonance I have ever experienced. History tells stories of heroes and saviors who risk their lives for the sake of the greater good. 

Was it an easy decision for everyone else? Do all heroes have a choice?

I kept thinking about Theodore Roosevelt’s “The Man in the Arena” speech, and Brené Brown’s research that integrates this quote into the definition of vulnerability and wholeheartedness (1).

"The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds…”

I wasn’t in the arena. I avoided the arena. My heart begged not to go into the arena.

What I’m learning after talking with many other nurses, NPs, physicians, and various front-line workers, is that I’m not the only one with these feelings. In fact, there are many who wished they could have stepped back, but simply did not have the privilege of choice.

So here I’ve stood, on the periphery of the arena, as my colleagues’ faces are marred by dust and sweat and blood.

I’ve done everything I can think of to support them from out here. I’ve donated money and PPE, I’ve bought coffee, I’ve helped many nurses leave their jobs and find new ones, and, maybe most importantly, I’ve stayed home and worn a mask when I'm occasionally in public.

What I’m learning over time is that my arena is different than what I thought it had to be. 

I may not be in the hospital, but in my other professional role I am holding space for and mentoring nurses and clinicians on the front lines. I am giving them the professional advice that I myself had to take — telling them that it is OK to prioritize their safety, that how they are feeling is OK and valid, and that they cannot provide the best care for their patients if they themselves are not well, physically and mentally. 

Beyond that, I am striving valiantly as a mother. Since the start of the pandemic, my 3-year-old twins have turned 4, and I’ve had to navigate their confusion about affection. Up until now, it was always safe to hug someone you loved. There are different parameters now. 

My “new baby” has since learned to crawl and walk; she's said her first words, gotten her first six teeth, and had her first birthday.

I know my situation is not unique. This is an example of where personal and professional priorities intersect, and this intersection is messy. This isn’t the first challenge I’ve had to navigate as a health care professional and parent, and it likely won’t be my last. 

Coping with my decision has become easier over time, and I’m glad to say that my head and my heart finally agree.


  1. Brown, B. (2012). Daring greatly: How the courage to be vulnerable transforms the way we live, love, parent, and lead. New York: Gotham Books.

Amanda Guarniere is a dual-certified adult and women's health NP with a focused clinical background in emergency medicine. She holds a BA in Italian Literature and Violin. She believes strongly in the healing and educational power of storytelling. She is also an entrepreneur and works with other NPs as a career mentor so that they may find personal and professional fulfillment. She is a 2020–2021 Doximity Op-Med Fellow.

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