Nurse teaches peers to practice empathy with personal boundaries

December 15, 2012


The last assault was no more brutal than the others. As a mental health nurse, Thomas Browning had been attacked by patients before. This time, however, Browning had had enough.

"I was exhausted, emotionally and physically," said Browning, who was working at a large, Seattle hospital. "And I was also spiritually disconnected. I had lost a sense of meaning and purpose. There was nothing really feeding me."

In other words, Browning was burned out.

Browning quit his job in 2008 and decided to start fresh in a new career. But nursing called him back.

"I realized my career was not a light switch," said Browning.

He embarked on a one-year sabbatical during which he reflected on his experiences and studied the psychological and biological causes of burnout.

That research is the basis of "Holding and Releasing," an eight-hour seminar for the nurses of Tacoma, Wash.-based Franciscan Health System, where Browning now works as a psychiatric nurse. Browning explores ways the nurses can feel empathy for their patients without internalizing their pain.

Weight of suffering
"I ask the nurses the questions I asked myself — how can we be well in these dynamic environments?" said Browning, who introduced the program two years ago. "How can we carry the weight of the suffering that we witness every day without letting it accumulate?"

Nursing schools don't or can't answer these questions, said John Mueller, Franciscan Health System's director of education services. Students are so focused on mastering medical facts and mechanical skills, they cannot imagine — much less prepare for — the pain they will witness.

Mueller will never forget the night that he, as a young nurse, prepped a woman for surgery. She had attempted to commit suicide by jumping off of a high building. Her legs were shattered. Still, Mueller was stunned when she returned from the operating room with no legs.

"It came as such a devastating shock to me," said Mueller. "I was screwed up over that. That was 18 or 19 years ago, and that (is) still a vivid thing for me."

Faulty defense mechanisms
Not all hospital nurses react the same way to the type of cumulative emotional trauma that may be an unpredictable variable of their jobs, said Mueller. Many get hard, others get sick.

"We've all met nurses who are very cynical, very blunt, very seemingly diffident and frankly have really crappy bedside manner. More often than not, if you scratch the surface, what you see is someone who has been hurt and doesn't want to be close to the pain anymore," said Mueller. "You also see so many nurses with an unhealthy lifestyle, whether it's obesity or smoking or, what's never talked about, substance abuse. We don't have statistics, but what we feel intuitively is that some of the responses to trauma are literally career ending. It's like a permanent back injury."

Releasing pain
During the class, Browning explores a number of scientific concepts from trauma exposure response to post-traumatic stress disorder to empathy training to explain how the human body and brain respond to crisis. He has found that nurses, so good at recognizing their patients' pain, are poor at assessing their own.

"There are a lot of things that get in the way of how we observe ourselves, so we look at mindfulness and becoming more present," said Browning. "They're all on a spectrum, but even on the lower end of the spectrum people suffer — cloying cynicism can come in slowly over time, and it can start to grow from there on the spectrum until it starts to look something more like disconnection."

Browning offers a range of coping tools including meditation, breathing exercises and image management to help students release suffering.

"If you've witnessed something extreme — and most of us will — that tends to freeze itself into an image, or a sound, or a smell," said Browning. "We talk about how to manage those images. These are things firefighters and police officers and people in the military all learn but we are never taught."

The goal is for caregivers to develop their own strategies to release accumulated stress and pain. Browning practices aikido, a Japanese martial art that emphasizes posture and breathing. He also seizes small moments at work to reflect. Browning meditates as he washes his hands and takes a deep cleansing breath at the end of every shift.

"With that breath, I release my connection," said Browning. "Within it is an acceptance and a gratitude for the good work that I did. It's not 100 percent. I can be driving home and think I didn't do this or that, but that's the spirit of it. Finding rituals like that can be very powerful."

Wake-up call
The class has received great reviews from nurses. In an effort to reach more caregivers, Browning will offer a four-hour version of the class next year.

"Everybody should take this course," said Mueller. "If we do that, it would change our clinical culture. The people who take this course are far more sensitive to their colleagues but also themselves. The course gives them real-world skills they can bring to the workplace when they really need them."

Mark Moore, an acute care nurse at Franciscan's St. Joseph Medical Center in Tacoma, agrees. He called the class a wake-up call.

"We're in huge denial about how much pain we absorb," said Moore. "I get tired of bearing other people's pain. I get tired of things not being enough when I'm putting out 200 percent."

Like Browning and Mueller, Moore said nursing school did not prepare him for the trauma he would witness.

"When you're a student, you know nothing," said Moore. "Your experiences are so minimal. You're just happy to be working with patients. You're focused on how many drops per minute; did I do my charting? You're not even thinking about your emotions."

Moore, a devout Catholic, said he has tried to develop his own rituals to help him release suffering, including praying to the rhythm of his footsteps. But the most valuable lesson is to be mindful.

"Don't forget you could lose everything in this profession — you could be prematurely disabled or out of career," said Moore. "It's a powerful message to a group of people who live in denial of the risks we take daily."


Copyright © 2012 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2012 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.