In Practice: Reflections from NPs and PAs

Scott Cuyjet, RN, MSN, FNP-C, practices adolescent medicine in the San Francisco Bay area.

 

As a nurse practitioner, I was taught to not be too emotional or share too much about myself with my patients so as not to make the clinical visit about me. I have learned over time that being emotional and sharing does not come easily for me, nor is it always in the best interest of the patient.

Granted, every situation is different and should be assessed prior to showing emotion or drawing a parallel to one’s own or another patient’s experience. In an emergency, there is often no time for this until after the event is over, and although a provider’s actions should still be guided by kindness and empathy, an emotional decision could be fatal. However, in non-emergency encounters, when someone is telling me a story about being abused, for instance, it can be appropriate and necessary to feel and express some emotion in a show of empathy to assist the healing process. Patients want to know that their provider is human and not an automaton. Sometimes I generalize information about other patients who have experienced a similar health situation so that a patient doesn’t feel so alone and isolated. Other times, I share my own experience — as a teenager growing up and getting into trouble, or as a parent of teenagers — with my teen patients and their parents to make the point that things kids do during adolescence don’t always define who they will become later in life. Ultimately, as providers, we have to do what feels comfortable and comes naturally to us so that it does not come across as awkward or forced and have the opposite effect of making a patient feel uncomfortable.

Given that I feel this way as a clinician, I was surprised when I recently found myself specifically not sharing my emotions as the family member of a critically ill patient, my grandmother. I was away from my home and family, helping to guide my mom who had power of attorney, and I realized that I was not allowing myself to feel. When hospital staff or family members asked how I was doing, I would give an analytical response about my grandmother’s condition and why this was the appropriate course, which helped me avoid my feelings, as I did not want them clouding my judgment. Given the emotional intensity of the situation, and my lack of sleep from sleeping in a chair in the ICU, I was starting to break down from the inside as well as the outside, which made me less capable of supporting my mom, who needed it the most. I also had not been able to run, bike, or go to yoga class as I do in my daily routine. When my grandmother was transferred out of the ICU to the floor, a nurse asked me how I was doing, and I finally broke down and told her how I was feeling. It felt really good to put down the weight I had been carrying so that I could continue to take some of the burden off my mom. As I walked away, I thought about how nurses also need to be nursed sometimes, not just patients.

Sometimes it is difficult to accept help when you are a helper. But it is hard to help others heal when we are in pain ourselves, so it is important that we clinicians make sure we take time for self-care.