Woman in hospital scrubs smiling and showing heart symbol with her hands
HealthMarch 23, 2021

Chocolates and tissues: Nursing is a work of heart

By: Lenore Cortez, MSN, RNC
Nursing is a career that involves stamina and heart. It is not a career for someone who just wants to go about their day and leave it at the door before they head home for the night.

I have always found that I take home a bit of my day with me, processing how things went and who I met during my shift. Some days are definitely better than others. It can be emotionally draining work. Although I am a full-time nursing faculty member, I do maintain my practice working per diem on a locked behavioral health unit. The people I see and the stories they tell me of the hardships they have faced are quite humbling. I often re-assess my life based on what I have heard on any given shift.

Keeping the work meaningful

How do I go about my work without burnout? Truth be told, there have been times in my life when I really needed a break from this work. I could feel myself becoming jaded against the very people I was trying to help. Mental health nursing does not involve a lot of thanks from the patients. They are simply trying to make it to the next day, hour or minute. When they are in an acute state of depression or psychosis, they don’t have the energy to focus on anyone but themselves. I have been yelled at, sworn at, grabbed, slapped and had things thrown at me.

But once in a while, there will be the patient who begins to feel better and softly says, “thank you.” Those are the moments I cherish. I don’t do this work for the accolades because if that is what I expected I would be sorely disappointed. I do this work because I like to be in the moment with my patients when they have no one else to support them and listen. A qualitative study by Ward (2011) enlisted 13 female mental health nurses to talk about their experiences in this specialty area. The common thread in this study showed that when these women spoke about job stress it was related to nurse-patient ratios, shift work, and a chaotic environment. They all reported their pride and satisfaction with caring for patients and “being there” (p. 83) with those patients.

When I talk with my patients, I ask about their lives outside of the hospital. I try to learn a bit about them that is not listed in their chart. I want to have a human connection that I can talk about the next time I take care of them. This is especially helpful for gaining a rapport with the patients who are frequently readmitted. It is really nice to be able to ask them about a particular thing in their life and have them be surprised that I remembered that bit of information. It makes them feel good which in turn makes me feel good.

Caring is something that we also need to extend to our students during this present time of transition to online learning. Jean Watson’s caring theory has three parts: the caring factor, creating the caring relationship and being there in the caring moment (Lachman, 2012). These same factors that we apply in our nursing practice can be applied to pedagogy in the sense of being present for our students. How can we help them to overcome the uncertainty they are facing due to the many changes that have occurred since March 2020? Being genuine by admitting that we have some of the same concerns opens up a brand-new teacher–student perspective. We are all in this together, moving forward one step at a time.

Work-life separation

I admit that it can be difficult to stop thinking about certain patients once I get home from a particularly busy shift. I sometimes wonder how they got to where they are in their lives. Why did they make certain choices? What happened to their family to make them no longer supportive or in the lives of the patient? I wonder if the patient will still be there the next time I go to work.

I really try to limit the amount of time I spend thinking about work once I am home. Due to HIPAA, I only talk about my shift in the broadest of terms. When I do share a story or two, I often get blank looks from my family because they are not nurses, and just don’t get it. I suppose it is like being in any industry…there is a certain vernacular to most occupations that is only understood if you work there. So, this is an example of me talking about my day, “We had a patient admitted for psychotic behavior whose urine drug screen was positive for benzos and THC. He was paranoid, had SI and AH to kill himself. He became aggressive and needed a B52.” Of course, this could be followed by talking about the constipated patient that I had to give an enema or the patient who had not showered for a week. The conversations that nurses have, or want to have, often turn the stomachs of people who do not work in health care.

What I have found best is to just give a few highlights of my shift. My family gets that I do something that a lot of people cannot stomach. There is still a lot of stigma and misunderstanding regarding mental health. I know other nurses who would never be caught in this specialty. If there is something really pressing that I need to share or get off my chest I will text a nurse friend to vent because even if they are in another area of nursing, they are good at giving advice as to how they would handle similar events, offering support, and pushing me to let it go.

Expansion of self

Nursing as a career can be as varied as the individual wants it to be. I have worked in mental health (hospital and community-based), home health, geriatrics, a walk-in clinic, diabetes research, and nursing education. My career has been a curvy road of adventure. I love it! Each new role builds on the previous nursing role and strengthens my practice. I am a better nurse because of all the varied experiences I have had since I became a nurse in 2004.

Autonomy is what nurses strive to achieve. According to Weston (2010), autonomy allows the nurse to work within their scope of practice delivering patient care using their education and critical thinking skills. Being trusted to think on their feet and make appropriate decisions is how nurses grow as individuals through the experiences they have in their work environments. Communication with, and support from, the administration should further strengthen the sense of self. Nurses are with the patients 24/7. They are the eyes and ears that often detect subtle changes in patients and must use their critical thinking skills to formulate quick determinations about the need for emergent care.

I have had people say to me that they don’t know how I do what I do. I usually smile and respond that I love what I do. Nursing is like that. You have to really love it to be good at it. Your patients will be able to tell if you are not really invested in your job. That lack of enthusiasm will be apparent in the care that is given. I don’t want to be “one of those nurses”. I want each of my patients (and students) to feel they were treated with respect, received the best care possible, and had someone there to listen when they really needed it. The mental health nurse participants in Ward (2011) all mentioned “looking at the positive, as opposed to the negative, and finding joy in small achievements, and success inpatient recovery” (p. 80). I try to do this every day in my nursing practice. Can you say that about your nursing practice?

Missed parts 1 through 5 of chocolates and tissues? Read them now:

Lenore Cortez, MSN, RNC
Expert Insights Contributor for Wolters Kluwer, Nursing Education
  1. Lachman, V. (2012). Applying the ethics of care to your nursing relationship. Med Surg Nursing, 21(2), 112-114.
  2. Ward, L. (2011). Mental health nursing and stress: Maintaining balance. International Journal of Mental Health Nursing, 20, 77–85.
  3. Weston, N. J. (2010). Strategies for enhancing autonomy and control over nursing practice. The Online Journal of Issues in Nursing, 15(1), http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/Enhancing-Autonomy-and-Control-and-Practice.aspx.
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