Empathy in Nursing: Understanding and Cultivating an Essential Skill

Empathy in Nursing: Understanding and Cultivating an Essential Skill

Nowadays, “empathy” is one of those vague qualities that online quizzes love to throw around – and it is often treated as something you either have or don’t. But empathy in nursing is not just a “nice to have” personality trait.


Empathy in Nursing
Ximena Lama-Rondon


June 1, 2023

Empathy is a vital soft skill we will need to cultivate and a tool that will shape our relationship with patients. After a few years on the job, it can even be a resource we need to take good care of.

Suddenly, that’s a lot more complicated! So is empathy a deal-breaker? Can we learn it? Can we improve it? Yes, yes, and yes! Let’s take a closer look.

Empathy Basics

What is empathy?

Empathy is the ability to see, understand, and feel what others do without judgment. It is one of the key ingredients of effective communication, as it helps us interpret non-verbal cues, create trust more rapidly, and see the other person as a whole. 

Through empathy, we can look at someone’s experience, connect with them, and even predict what they are not saying. This allows us to alleviate their suffering, provide constructive advice, and even notice when we are being lied to (and why!) – all tasks that come in handy during everyday nursing practice!

What empathy isn’t

Empathy is not sympathy or pity. If you see someone in pain and feel bad for them, you’ll feel uncomfortable and move on – that’s sympathy. Empathy can involve the same discomfort as sympathy, but it will compel you to remedy the situation. 

Likewise, empathy is not the same as enabling poor behaviors or condoning violence, and it doesn’t require you to like the other person. If a patient gets violent, you can empathize while you call security.

Empathy in Nursing Practice: How Does It Come Into Play?

Almost all career guides and manuals emphasize the importance of empathy in health and nursing care. All humans (bar a few severe personality disorders) are capable of putting themselves in someone else’s shoes. However, we don’t all experience empathy to the same degree or in the same situations.

If you’re working directly with patients, you will need to actively expand the limits of your empathy beyond what regular people do. Why? Because study after study has shown that it will affect the quality of care you deliver, improving recovery rates and decreasing the chance of complications.

Empathy increases understanding. In turn, a deeper understanding between people will help you:

  • Create a foundation of respect between you, your patients, and their families
  • Establish a stronger therapeutic alliance where they’ll be more likely to listen to you
  • Guide you through ethical decisions while respecting the wishes of the client
  • Provide the care that is needed when it’s needed

Does this all sound very abstract? Then, imagine you are talking to an older man with poorly-controlled diabetes who is now at risk of amputation. Let’s call him Bob. He’s heard the usual spiel about eating healthy and taking his medication on time, and it always feels like the same: an authority figure judging him for his lack of self-control.

Instead, you show genuine curiosity for Bob’s home life. You learn that Bob keeps having sugary cereal and milk for lunch because his wife can no longer cook, and he never learned how. He can’t drive very well but doesn’t want to burden his daughter, so he avoids going to the supermarket and stocks up on something that lasts. 

So you help him set up a regular grocery delivery service with more varied foods and tell his physician so his insulin can be adjusted. As he sees you listen and care, Bob mentions a lingering pain on his hip, where a bed sore is forming. And when his family doctor shows up with a stern face and negative news, he asks you to explain what those “survival rates” and “multidrug resistance” are really about. 

Feeling Is Not Enough: 3 Ways to Practice Empathy

If there’s something we can learn from Bob, it is that we need to act with empathy. You need to listen to your patient and let them know you are doing it. You’ll need to engage in deep conversation while respecting their boundaries but without making it all about you.

Here’s a good start:

1. Name the emotion

Often, we assume that everyone can tell exactly how we are feeling – even if our angry face appears sad or our exuberance can be attributed to excitement when it’s really anxiety.

How do we start to untangle this misunderstanding? By naming what we can see. Something as simple as telling a patient, “You look sad,” is enough to start the conversation. If you got it right, great! They will be more likely to open up about it without fear of being a bother. They’ll correct you if you got it wrong – and you can work from there.

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2. Explore its depth

After discovering that Bob is not really sad but scared, it’s time to see the details. This is the time to be direct yet gentle. Ask them if they want to talk about it, and let them know you will be better able to help them if they do. Then, give them the time to talk as much as they want.

If they ask you to back away – fine. Don’t push it and preserve the small gains for later.

3. Be explicit about your actions

Hospitals often run on routine and protocol, even if most of the action happens away from the patient’s eyes. But the patient needs to know about them! 

Maybe it’s something super obvious to you: for example if someone is impatient about their next blood results. Of course, you can’t take over the lab and do them yourself, and you have to wait until the results are sent to you, so tell the patient that you will let them know as soon as you do.

Yes, you were going to do it anyway, but hearing it from your mouth is still powerful.

Is Empathy Harming You?

As with any other skill, empathy takes effort. Exploring the feelings and concerns of others can have a high emotional cost for us. We all hear about nurses who become desensitized to the patient’s pains because “they’ve seen it all” and don’t have any more of themselves to give.

I don’t think any nurse starts their career with this attitude. We land there – and we’re all at risk of it! – after years of repeated bouts of “compassion fatigue.”

Compassion fatigue is not the same as burnout; whereas the latter develops slowly after years of dealing with emotionally-demanding jobs, compassion fatigue can be much more abrupt. It often happens when we are exposed to someone else’s traumatic experiences, and it happens precisely because we felt the experience too much. This can happen after working closely with an abuse victim or watching a special patient suffer, worsen, or die.

If it becomes recurrent, compassion fatigue can lead to depression or more pervasive burnout.

Eventually, after too many episodes of compassion fatigue, it feels easier to remain detached. Other times, the “cost of caring” can involve insomnia, trouble concentrating, chronic body pain, and feelings of hopelessness.

What can we do to prevent this? I’m only a student, but after dealing with a particularly gruesome case, I felt compelled to ask a few E.R. nurses who worked with me. They recommended two things:

  • To let my feelings out – whether by kickboxing, loud crying, or just talking about it with my classmates. Grinning, bearing it, and pretending we don’t care is not healthy in the short or the long term.
  • The “two-week rule.” Talk to a professional if an incident or patient keeps haunting you after two weeks.

Final Thoughts: The Empathy Well is Not Bottomless

Empathy in nursing is a necessary tool of the trade. And just as we would invest in a better stethoscope or the right pair of shoes, we should invest some time in deepening and refilling our empathy reserves. Caring for ourselves first is part of our professional obligations – not just because it allows us to care for others.

We've been there.
We get it.

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