Contributor – Justin McFail, MSN, RN

Understanding how to care for myself is not selfishness, it’s altruism for oneself. The adage goes something like, “you can’t pour from an empty cup.” If there’s one thing that I’ve learned working, broken, exhausted, and maybe perhaps recovered from the years of my life that nursing has given and taken away, it’s that we need to learn how to shape a sturdy cup and what we require to fill it again and again.

As a young nursing student, I was “raised” in a program that touted the virtues of Neuman’s System Model. Multiple lines of stressors, prevention, and defense. Ways in which the physiological, psychological, sociocultural, developmental, and spiritual variables interplay with internal and external stressors. All of this is built on the understanding that the nurse’s job is to keep the patient well. Yet, all these years later, I realize, we were never told, who keeps the nurse well?

All parts of Neuman’s theory focus on the stressors occurring with the patient. The job of the nurse is to understand, control, and try to prevent these stressors from causing greater harm to the patient. At an abstract view, this makes sense. Our job is to care, to provide, to prevent harm, and to promote wellness for each and every patient to the best of our abilities each and every time. It is here that I pause and take a moment to stop and consider just how much responsibility we take on.

I am a control freak, a perfectionist. I want every little detail to be mine to fiddle with and it all to be perfectly in its place. It’s what makes me an ICU nurse. It’s what makes many, good ICU nurses. It is also, what leads to second victim syndrome.

There are forces that act upon us outside of our control. I can’t stop the world from turning, no matter how hard I try. I found over time, if I try to control too much, if I try to be perfect, every. single. time. That my cup will shatter, and I will break along with it.

As I have grown over the years, it’s taken me a long time to give myself the grace for mistakes I make. For the burdens I carry with me over the years. The med errors, the falls, the CAUTIs, the CLABSIs, the pressure injuries, and the deaths, especially the deaths. All the things I could have prevented. All mistakes, that were my job to prevent. All of them could have been avoided, if only I were better. If only I were perfect…right?

The ANA’s Code of Ethics outlines 4 major principles; provisions all nurses must live by as we practice, providing safe and compassionate care. Their words, not mine. Autonomy, Beneficence, Justice, and Nonmaleficence. Four pillars we beat into our young over and over again.

I in no way disagree with these pillars and I truly believe every nurse should be committed to the patient’s best interests. But I worry, that I often see rhetoric sanctifying martyrdom. Sachs and Wheaton describe those prone to second victim trauma as, “hard-working, self-sacrificing, and altruistic humans.” I fear that these commendable virtues are being exploited by many in high places. That those with power justify abuse claiming that by not self-sacrificing, by not working overtime, by not pushing ourselves to our physical limits, we nurses are failing our patients. Because taking a moment for us, means we are taking time away from our patients. The health system isn’t paying us to eat lunch after all. There’s always work to be done. Work no one else can seem to do.

Well intentioned women in ivory towers have defined nursing theory by four great metaparadigms: person, environment, health, and the nurse. All of these, everyone, and everything, a professional nurse does is focused on someone else. It is always with the mindset of patient-centered care, patient-centered responsibility. Even the “nurse” description focuses not on the nurse themselves, but on what the nurse does for someone else.

It leaves me to wonder, what does the nurse do for themselves?

At work, some days, I’m known to be a bit of an intimidating force. It comes naturally, whether intended or not, when you’re 6 ft tall and built like a member of the Penn State defensive line. I remember one time, a coworker, a rather juvenile duckling on our unit, needed to take a break. It was almost 3pm and she hadn’t sat down or nearly eaten since the start of the day. We got into a bit of tiff about her pausing her patient care and allowing herself a moment of self-care. My voice raised and it was clear I was NOT going to take “no” for an answer. The nurse WAS going to step away. One of our NP colleagues joking chided, “a bit of horizontal violence, eh? Turning into a bully?” To which I quipped back, “it doesn’t count as bullying, if you’re bullying someone into self-care.” We laughed. The duckling took her break and felt better afterwards.

It’s moments like this that give pause for reflection. Why should I have needed to escalate, to raise my voice, and sternly force someone to take a moment of selfishness. And in that moment, that’s what the nurse felt like it was, “selfishness.”

In reality, her patients were fine. Perhaps they weren’t perfectly as “fluffed and puffed” as she would have liked, but they were safe and there was nothing that needed done that couldn’t have waited 15 minutes, or even 30. In those moments, it’s not selfish to refill your cup.

I worry sometimes when I see bright eyed nurses burn away, become jaded, loose the fire they once claimed. I worry, that we’re teaching them only how to pour from their cups, without teaching them how build one, and how to refill.

About Justin McFail

Justin graduated in Spring 2022 with a Master of Science in Nursing – Nursing Education from Millersville University. A registered nurse since 2015, Justin has worked in various specialties including medical-surgical and intensive care areas. In 2020, Justin volunteered as part of the Special Pathogens team in his home ICU. Currently, he still works in the Surgical ICU, which thankfully, has seen less COVID-19 patients. He is also an adjunct instructor and wearer of many hats for Millersville University. As an educator, Justin strives to bring creative models of education to the classroom.

Justin is also the author of the Nursology.net blog post “Holding Space for COVID-19 Nurses“