Have you ever found yourself in the middle of your shift when you make a mistake in the care you’re providing—and you wonder, “Am I losing my compassion?”

I have. It’s frightening, because what good are we as nurses without compassion? Sympathy and compassion can be hard to maintain in a job as stressful as nursing. Physical exhaustion or administrative pressures can get us so wrapped up in tasks that we forget what’s truly important to patients and their loved ones.

External stressors aren’t the only things that can rob us of compassion. Sometimes it’s our own attitudes. Imagine walking into a room where a middle-aged patient is requesting analgesics an hour after her radical mastectomy. The room is noisy, packed with husband, children, grandchildren, and friends so numerous they spill out into the hallway. They’ve come to wish your patient a speedy recovery. But look closely at their faces. In some of their eyes you read fear and unasked questions: Did the surgeon get it all? Will Mom survive this? What more must she go through before she’s herself again? You’re able to feel compassion for every person there. And the way you handle their fears shows you care.

Then you go next door to the room of a disheveled homeless man. He reeks of body odor and stale alcohol. As you walk in, he looks up and curses you. Would you find it easy to look beyond his outward appearance and attitude? Or would you have difficulty showing him the same compassion you showed the mastectomy patient?

I once heard a lecture by Fred Lee, author of If Disney Ran Your Hospital: 9½ Things You Would Do Differently. Lee said, “The opposite of compassion isn’t apathy or indifference. It’s judgment.” When we let our judgment lead us, we’re in danger of losing compassion.

Most of us chose to become nurses to help people in a meaningful way. But whom do we think of when we picture people? The dirty, down-and-out members of society? The chronic complainers—those we can’t seem to please, no matter what we do? What about people burdened with severe psychiatric illness? Or those our healthcare system labels drug seekers? What about registered sex offenders? Or patients who seem racist or sexist?

When I started nursing school, I was young, naïve, and prudish. Like all nurses, I was assigned to care for widely diverse patients; ultimately, they taught me to broaden my mental image of “the people I’m here to help.” I’ve had to learn (sometimes the hard way) to replace judgment with true compassion. On some days, I’ve gone home regretting the way I treated someone.

No help needed

Some people don’t want our help, but they do want our compassion. Long ago my husband and I built a house. The lead contractor—I’ll call him Tony—worked with a hammer or nail gun in his hand, but he usually rested with an unfiltered cigarette in his mouth. Several years later Tony was my patient, diagnosed with inoperable lung cancer. His oncologist told him the treatment would be ineffective if he didn’t stop smoking. When Tony wanted to go outside to have a cigarette, I repeated the doctor’s warning to him. He replied, “Why should I quit? I enjoy smoking. The treatment they’re talking about might cure the cancer, but if I have to give up my smokes, I really don’t want to live.”

If that had occurred early in my career, before I truly understood addiction, I would have reacted differently. The knowledge that tobacco use is the leading preventable cause of cancer would have made me frustrated with Tony’s unwillingness to give treatment a chance. That frustration would have colored my view of him in a negative way, and my care would have been less compassionate.

But by then I’d learned it’s okay for others to have values different from my own. So instead of frustration, I felt sorrow for Tony—anticipatory grieving. And the sorrow influenced my compassion in a positive manner.

The gift of empathy

After Tony died, my husband showed even more compassion when he said, “What a terrible price to pay for an addiction!” Empathy is the foundation for compassion. It means being able to identify with someone else’s suffering. It’s a gift we should treasure greatly.

Many of us have been around long enough to have had a ringside seat at the brutal boxing match between parent and dementia. We’ve walked through the valley of the shadow of death with our own loved ones. We’ve spent time sitting at bedsides, waiting to meet with doctors to discuss a diagnosis, a plan, a prognosis. These experiences cultivate empathy, which helps us become better nurses.

Some of us have been the patient. We’ve felt the helplessness and humiliation of lying exposed as clinicians poke and scope and scan us. We’ve trembled in fear (while trying to look nonchalant) as our gurneys are wheeled toward the operating room. We’ve come to know firsthand the crippling effects of migraines or arthritis. We’ve experienced the insidious erosion of our psyches by chronic pain. From these experiences comes empathy, in hearty doses.

For those of you who haven’t developed that kind of empathy, you can still retain your sympathy and compassion. But you’ll need to pay attention to your reactions. Admittedly it’s hard work to push your heavy judgments behind you. Retaining compassion takes the purposeful action of looking beyond your patient’s appearance, history, or attitude. It requires you to focus on what you read in the depths of the patient’s eyes.

Over the years, I’ve come to believe my own behavior might resemble that of my “difficult” patients were I in their shoes. Often, I’ve looked beyond a patient’s churlish nature to see the angry, distrustful, or fearful person who just wants to be cared for with dignity and respect.

Do I still sometimes forget to do this? Of course—especially if I’m tired, or stressed, or tugged in several different directions. And I know I must pray often that I won’t let my judgment rob me of that vital jewel of nursing—compassion.

Anne Warden is an acute care nurse at Skagit Valley Hospital in Mount Vernon, Washington.