The cost of caring
Surviving the culture of niceness, occupational stress and coping strategies
Palliative care nursing occurs in a context of significant human suffering, suffering in which nurses are both witness and participant. As palliative care nurses, every day we deal with people facing one of life's greatest challenges – people who are often distressed, in pain and struggling with questions of meaning. We are not immune to this suffering and, for most of us, our reason for working in this field is a desire to make a positive difference in the lives of dying people and their families.
We work in a setting that for the rest of health care is associated with the failure of modern medicine to hold death at bay. Our work is also often hidden from view in a social context where there is both a fascination with death and an avoidance of its proximity. We are lauded for the work we do because others see it as distasteful, yet the skill of our work is seen as hidden (Aranda 2001), innate rather than learned. Nursing in palliative care is even described as the quintessential spirit of nursing (Bradshaw 1996) – potentially little more than attention to the basics. For me, such beliefs minimize the complexity of our work and undermine the skill – a skill that is a combination of disease knowledge, clinical expertise and human compassion.
Believing that palliative nursing is natural rather than learned leads to what I consider to be a clear paradox in the self-perception of palliative care nurses – on the one hand, this is something everyone with a bit of humanity can do and, on the other, it is hard work and skilled practice. This paradox means we work in a constant balance between emphasizing the ordinariness of what we do and having to defend the need for skilled nurses in the delivery of palliative care. If nurses are to survive and even thrive in this context, attention must be paid to the skills and supports required to do this.
While occupational stress and burnout are common phenomena across health care and certainly not unique to palliative care, there are some characteristics of palliative care as a specialty that require specific attention. In this chapter, while acknowledging the significant work undertaken on