“Never Finally to Be Answered” - A Nurse’s Guide to Grief and Lament
Tenley Force, Duke Divinity School, Durham, NC
Due to reality shock [1] and transition shock [2], becoming a nurse is not easy. Due to moral distress [3] and moral injury [4], staying a nurse may be harder yet. While rising rates of burnout can be attributed in part to the Covid-19 pandemic, chronic nurse burnout was an issue long before [5]. This chronic burnout is a systemic problem [6] that in many ways calls for large scale systemic changes [7] to the health care and hospital systems. Since such changes do not appear imminent, what are nurses to do in in the meantime?
There are many proposed treatment plans for burnout that are readily accessible through a quick internet search, but this paper hopes to fill a persistent gap by focusing on questions the burnout literature does not take up. The questions are: 1) how should nurses address their own grief? and, 2) what shape should lament play in that task? When burnout arises within oneself, one experiences a dis-coherence. With burnout, we are split from ourselves, within ourselves. The goal of the present project is not to help nurses stay in nursing, nor help nurses help themselves so that they can provide better patient care, although both would be welcome outcomes. Ultimately, the goal is to help nurses find coherence within themselves again.
This paper will address grief and lament in four parts. First, I will look briefly at theodicy through the work of nurse and theologian John Swinton [8]. Second, I will investigate what factors uniquely contribute to the grief of nurses, with examples from personal nurse stories. Third, I will introduce the practice of lament and why it is important. Fourth, I will walk through Scriptural passages from Lamentations and Ecclesiastes to unpack what it looks like to grieve and lament well. Ultimately, I will propose that for nurses to return to themselves, to revert from machines back into humans and find a re-coherence, they must learn to wrestle well with lament even in the spaces and moments where grief is never finally to be answered.
[1] Marlene, Kramer, Reality Shock: Why Nurses Leave Nursing (Maryland Heights, MO: The C.V. Mosby Company, 1974) 3-4.
[2] Judy, Boychuck, Duchscher From Surviving to Thriving Navigating the First Year of Professional Nursing Practice, 2nd edition (Wildwood, Saskatoon, Canada: Nursing the Future), 14.
[3] Andrew Jameton, “Nursing Practice, the Ethical Issues,” International Journey of Nursing Studies Vol. 22, Issue 4 (Englewood Cliffs, NJ: Prentice-Hall, 1984) 343.
[4] “PTSD: National Center for PTSD,” online: https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury_hcw.asp, accessed 30 October, 2023.
[5] Linda H., Aiken, Douglas M., Sloane, Matthew D., McHugh, Colleen A., Pogue, Karen B., Lasater, “A Repeated Cross-Sectional Study of Nurses Immediately Before and During the COVID-19 Pandemic: Implications for Action,” Nursing Outlook, Vol. 71, Issue 1 (New York, NY: New York University, 2022), online: https://doi.org/10.1016/j.outlook.2022.11.007, accessed 30 October 2023.
[6] “Moral Distress and Moral Injury- Recognizing and Tackling it for UK Doctor,” British Medical Association, online: https://www.bma.org.uk/media/4209/bma-moral-distress-injury-survey-report-june-2021.pdf, accessed 30 October 2023.
[7] “New Surgeon General Advisory Sounds Alarm on Health Worker Burnout and Resignation”, online: https://www.hhs.gov/about/news/2022/05/23/new-surgeon-general-advisory-sounds-alarm-on-health-worker-burnout-and-resignation.html, accessed 30 October 2023.
[8] John, Swinton, Raging with Compassion: Pastoral Responses to the Problem of Evil (Grand Rapids MI: Eerdmans Publishing, 2007), 9-45.
There are many proposed treatment plans for burnout that are readily accessible through a quick internet search, but this paper hopes to fill a persistent gap by focusing on questions the burnout literature does not take up. The questions are: 1) how should nurses address their own grief? and, 2) what shape should lament play in that task? When burnout arises within oneself, one experiences a dis-coherence. With burnout, we are split from ourselves, within ourselves. The goal of the present project is not to help nurses stay in nursing, nor help nurses help themselves so that they can provide better patient care, although both would be welcome outcomes. Ultimately, the goal is to help nurses find coherence within themselves again.
This paper will address grief and lament in four parts. First, I will look briefly at theodicy through the work of nurse and theologian John Swinton [8]. Second, I will investigate what factors uniquely contribute to the grief of nurses, with examples from personal nurse stories. Third, I will introduce the practice of lament and why it is important. Fourth, I will walk through Scriptural passages from Lamentations and Ecclesiastes to unpack what it looks like to grieve and lament well. Ultimately, I will propose that for nurses to return to themselves, to revert from machines back into humans and find a re-coherence, they must learn to wrestle well with lament even in the spaces and moments where grief is never finally to be answered.
[1] Marlene, Kramer, Reality Shock: Why Nurses Leave Nursing (Maryland Heights, MO: The C.V. Mosby Company, 1974) 3-4.
[2] Judy, Boychuck, Duchscher From Surviving to Thriving Navigating the First Year of Professional Nursing Practice, 2nd edition (Wildwood, Saskatoon, Canada: Nursing the Future), 14.
[3] Andrew Jameton, “Nursing Practice, the Ethical Issues,” International Journey of Nursing Studies Vol. 22, Issue 4 (Englewood Cliffs, NJ: Prentice-Hall, 1984) 343.
[4] “PTSD: National Center for PTSD,” online: https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury_hcw.asp, accessed 30 October, 2023.
[5] Linda H., Aiken, Douglas M., Sloane, Matthew D., McHugh, Colleen A., Pogue, Karen B., Lasater, “A Repeated Cross-Sectional Study of Nurses Immediately Before and During the COVID-19 Pandemic: Implications for Action,” Nursing Outlook, Vol. 71, Issue 1 (New York, NY: New York University, 2022), online: https://doi.org/10.1016/j.outlook.2022.11.007, accessed 30 October 2023.
[6] “Moral Distress and Moral Injury- Recognizing and Tackling it for UK Doctor,” British Medical Association, online: https://www.bma.org.uk/media/4209/bma-moral-distress-injury-survey-report-june-2021.pdf, accessed 30 October 2023.
[7] “New Surgeon General Advisory Sounds Alarm on Health Worker Burnout and Resignation”, online: https://www.hhs.gov/about/news/2022/05/23/new-surgeon-general-advisory-sounds-alarm-on-health-worker-burnout-and-resignation.html, accessed 30 October 2023.
[8] John, Swinton, Raging with Compassion: Pastoral Responses to the Problem of Evil (Grand Rapids MI: Eerdmans Publishing, 2007), 9-45.