Healthcare Professional Burnout and Resilience

Courage to Nurse: Building a Community of Witnessing and Compassion

Among the privileges of being an academic nurse is having the opportunity to spend time with young women and men as they pursue their goal – sometimes their dream – of becoming a nurse.  When I ask first year undergraduate students about their decision to pursue a vocation in nursing, the most frequent response is that they are drawn to a profession committed to caring for people. And secondly, that they like science.  And so, when I hear of the many obstacles they encounter as they are learning in clinical practice settings, I become quite concerned. When the clinical setting is discouraging for bright, science-minded and compassionate learners, something is wrong.

Here’s an example.  Just last week, in a hallway encounter, an upper-year student confided in me. “I had a very difficult time in clinical last week.”  Without seeking details, I asked her what she can do to work through such a difficult time.  “Nothing.” she responded.  “You can’t talk about it, or you would look weak. You would draw unwanted attention to your vulnerability, and questions about your ability to cope.”

It’s not the first time I have heard something like this from a nursing student, and as I reflected on this experience, I was mindful of a conversation I recently had with colleague with whom I am exploring narrative practice.  We were discussing the importance of witnessing – and the reality that, like it or not, we are all always witnessing.  Around us people are speaking, and we hear things whether we choose to or not.  And all around us, people are actively engaged with the physical, and we see things, whether we want to see or not.  Sometime we are passive observers to the event, and other times, we throw ourselves into the middle, regardless of the threat of danger and harm.

Psychiatrist, Dori Laub (1992) talking about Holocaust experience, suggests three forms of witnessing: 1) being a witness to oneself, to one’s own experience; 2) receiving the testimony of others; and, 3) bearing witness the process of witnessing itself.  All of these elements need to be present, Laub stresses, to allow people to live their lives without merely subsisting in the shadow of the experience.  While it is risky to extend these qualities of holocaust witness to traumas less brutal and total, we can learn from Laub’s forms of witnessing in our own situations and histories.

I have had many experiences with the first two forms of witnessing. I have distinct memories of my experience as a nursing student – of the young man my own age, who was dying of liver disease (before a liver transplant was an option), and of his mother as she came to terms with the futility of his medical circumstances. Of the young woman whose psychiatric condition was so severe she had been an inpatient in a psychiatric facility for years. I remember these individuals as if I had just left their bedside; I believe that these were my first professional encounters with suffering. And as a young RN, I spent hours listening to my colleagues and roommates as they shared their stories, stories of the severely burned child or the neonate who didn’t survive.

Laub’s third form of witnessing is more difficult for me to understand and recount.  In this third form, the witness reflects on herself as she engages in the act of witnessing – as if holding up a mirror to herself, in order to reflect on the experience recounted in the story.  By reflecting on the story, the witness reclaims both agency and community, and integrates a new sense of meaning – personal meaning as meaning-in-community.  This form of witnessing is more complex. It begins with the reality that to engage fully in the act of telling one’s story, one needs a trusted witness, a witness who will not abandon the teller.  And one’s trusted witness also needs a community that can bear witness for them, so they do not have to carry alone the burden of this vicarious experience.  For when the witness joins the story as witness, they are both implicated (they have taken the story somehow into their soul) and at the same time not the subject (it is not the trusted witness’s story, and cannot become so). The witness, then, needs a witnessing community, a community that will support them in their witness to this story, that while not their story, has nevertheless joined itself to their life.

As I reflect on the words of the nursing student’s recounted above, it seems to me that she is telling us that she is not supported by a trustworthy witness, and that any such aspiring witness would lack a witnessing community. It is not simply a matter of a person willing to take seriously her struggle, to receive and support her witness to that struggle to sustain compassion and clinical capacity in the face of suffering, but also of a community that will support such a person in standing alongside her experience, of witnessing it, while at the same time granting her the dignity of agency in her own practice and in her witness to the loss/struggle that are part of learning both how to practice and how to sustain a sense of wellbeing as that practice encounters human suffering. It does not have to be the case where our nursing students and practicing nurses have to bear difficult and challenging experiences alone.

Through our AMS-funded Courage to Nurse work, we are working toward a different future, one in which nursing students and practicing nurses alike, can act as witnesses to each other’s experiences in a community of healing compassion.

About the author

Dr. Deborah Tregunno

“Courage to Nurse: The Development of Self-Identity and Compassionate Care” …

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