It’s the middle of the shift. You’re seven hours into a twelve that somehow feels like it’s been 3 days. The waiting room is overflowing, the entire ED is gridlocked and holding floor beds, Room 4 has called out 6 times in the last 30 minutes for things that aren’t emergencies. And you just helped out in your friend’s hour long code that didn’t end the way anyone wanted it to.
Somewhere between the IV pump in your C.Diff rule out room that won’t stop beeping and the ICU patient you still need to chart on, a thought floats around in your head: Why am I doing this?
Not in a dramatic, existential way. Just… tired. The kind of tired that makes you forget there was ever a reason you signed up for this.
So let’s talk about that. Because there was a reason. And it still matters.
Compassion Fatigue. I threw around the word a lot until I actually experienced it. Then I went looking for it in my work friends.
Here’s what the research tells us: there’s a strong positive correlation between psychological resilience and something called compassion satisfaction—that feeling of fulfillment you get from helping others (Alonazi, 2023). When resilience is high, compassion satisfaction goes up. When it drops, so does your ability to feel good about the work you’re doing.
And it has nothing to do with feeling like a miracle-worker every day. Low resilience is linked to higher burnout and secondary traumatic stress (Alonazi, 2023).
The bad news.
That heaviness you carry home after a bad shift? It’s real. It accumulates. And if you don’t have ways to process it, it starts to erode the very thing that made you good at this job in the first place. It also pushes you to look for greener grass in a burnt out state, likely creating cycles of job dissatisfaction everywhere you look (been there, too).
The good news.
Resilience isn’t fixed. It’s something you build. Which means the way you’re feeling right now doesn’t have to be permanent.
Take it from a gal who almost left a job she loved with her whole soul, in a burnt out, fatigued state. Spoiler: I’m still at that job.
Moral Resilience.
There’s a term that doesn’t get talked about enough in nursing school: moral resilience. It’s the capacity to sustain or restore your integrity when you’re facing ethical complexity, confusion, or distress (Rushton, 2016).
Think about the last time you had to do something that didn’t sit right with you. Maybe it was following a treatment plan you disagreed with. Maybe it was watching a patient suffer when you knew there wasn’t anything anyone could do. That discomfort has a name: moral distress. And if it builds up without release, it doesn’t just make you tired. It makes you question who you are.
Moral resilience is what helps you hold onto yourself in those moments. It’s not about ignoring the hard stuff. It’s about finding your footing again after it knocks you sideways.You try a twelve in the ED on one leg and tell me how grounded you feel.
None of this is about toxic positivity or pretending the job isn’t hard. It’s about staying whole enough to keep doing it.
Name what you’re feeling. Sounds simple, but most of us skip this step. After a rough code, a difficult family interaction, a patient who reminded you of someone you love, just pause. What’s actually going on in your chest right now? Research suggests that self-awareness is foundational to building resilience (Rushton, 2016). You can’t process what you won’t acknowledge.
Find your people. You’re not meant to carry this alone. Strong social connections act as a safety net when ethical challenges pile up (Rushton, 2016). The coworker who gets it, the one you can debrief with in the break room, the one who knows when you’re struggling before you have a chance to ask for help: those relationships matter more than you think.
Reconnect with your values. When everything feels heavy, come back to why you started. Not the polished answer you gave in your nursing school interview, either. I’m talking about the real one. Maybe it was a family member who was old or sick, or both. Maybe you just wanted to help people on their worst days. Whatever it was, it’s still in there. Reaffirming your core values is a powerful antidote to despair (Rushton, 2016).
Let yourself feel good about the wins. We’re wired to remember the codes that didn’t make it, the patients who yelled, the shifts that fell apart. But there were also moments today where you made a difference, and you know it. The hand you held. The IV you got on the first stick when no one else could. The scared kid you made laugh. Let those count too. I’m serious. View yourself through your patients’ eyes. Your skill, your clinical wisdom, your bedside manner. You mean something to a complete stranger. Let that matter to you.
A 2020 qualitative study found that both patients and nurses who worked through difficult times together often found meaning in the process (Candela et al., 2020). That doesn’t mean every shift will feel meaningful. Some shifts are just survival.
But over time, this work changes you. It teaches you things about life and death and human connection that most people never learn. That’s not nothing. So the next time you’re standing in the middle of chaos, exhausted, wondering why you do this, remember: you’re not just checking boxes in the EMR.
You’re showing up for people on the hardest days of their lives, even if today may not be easy for you either. And even when it doesn’t feel like it, that matters.
Your why is still here.
Stay well. Have a great shift.
EDNurseMentor
This post is for educational purposes and reflects my personal perspective as a bedside ED RN in a Level II Trauma Center. EDNurseMentor.com is my personal hobby and has no affiliation to my professional career as a registered nurse, instructor, and student, respectively. EDNurseMentor.com has no affiliation with any associations I am professionally a member of. Always follow your facility’s protocols and use your own clinical judgment.
Alonazi, O. (2023). The relationship between psychological resilience and professional quality of life among mental health nurses. BMC Nursing, 22, 190. https://doi.org/10.1186/s12912-023-01352-5
Candela, M. L., Piredda, M., Marchetti, A., Facchinetti, G., Iacorossi, L., Capuzzo, M. T., & De Marinis, M. G. (2020). Finding meaning in life: An exploration on the experiences with dependence on care of patients with advanced cancer and nurses caring for them. Supportive Care in Cancer, 28(9), 4493–4499. https://doi.org/10.1007/s00520-020-05300-8
Colville, G., & Affleck, S. (2020). Remember why you became a nurse in the first place. Nursing in Critical Care, 25(2), 71–73. https://doi.org/10.1111/nicc.12501
Rushton, C. H. (2016). Building moral resilience to neutralize moral distress. American Nurse Today, 11(10). https://www.myamericannurse.com/building-moral-resilience-neutralize-moral-distress/
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