COVID-19 has taught us many lessons. Some of those lessons are painful and some are hopeful. In the time of pandemic, focusing on the healing of the self means that multiple areas of pain and struggle must be explored. How do you forgive yourself as a nurse? What does it look like? What happens if you don’t? 

In Nursing language, forgiveness is an intervention for injuries or wounds that brings peace to a person wounded. The wounds may not be visible on the outside. Yet, thinking of a wound, we may automatically see the physical, like a cut, or break. Consider the simple cut, visible to self and others. We may intervene with soap and water followed by a protective covering. We don’t really think anything more about it after that. But what if the cut really needed stitches? Or what if the cut gets infected and debridement is required? Yet, we don’t really want to have to do that, so we continue to use soap and water, maybe we add an antibiotic ointment, and keep covering it with a protective covering? Say the cut still doesn’t heal and the intervention at that point is surgical with consequences not considered? 

When a wound is ignored, the result can mean a costly procedure that impacts life or work. The result could also be tragic like the loss of limb or life. How does this happen? Sometimes we ignore a wound because we are busy or distracted by our responsibilities or other wants and needs. Other times we may not want to face the pain and work involved to heal a wound. Maybe we have had a wound heal with very little attention and believe that we can get by with that again.  

It is easy to think about a physical wound in need of healing. But what about other wounds? Mental, emotional, and spiritual wounds? What about when we face something that is difficult to manage, difficult to handle. And what if the difficulty is continuous throughout a shift or a work week, or it is ongoing. Like what we are experiencing with COVID-19 pandemic. When we might do what we learned to do in our nursing education – but this time it is not working. When we start to feel overtaxed, overburdened, overwhelmed. When that feeling becomes a belief that now drives my way of thinking. When my thoughts create a new way of being that affects me socially, spiritually, physically, etc. When I believe that I am a victim to my circumstances, and I lose hope.  

Others may not realize that we are hurt. We may not recognize the wound like we would if we can see a cut on our arm. The emotional or spiritual wound becomes an imprint in our memory that shades our world. We may relive what the original injury was again and again, which is painful and may create other issues like the cut that gets infected. Forgiveness as the intervention brings emotional and spiritual peace. It is self-nursing care for self and others. To find peace, one must face the injury, come to terms with it inside of yourself, and release the rot and pus that has accumulated. 

My first code. The patient didn’t make it. I should have practiced more for this. I did not feel prepared, and I was not prepared for how I would feel afterwards. Should I even be a nurse? 

 How can we have compassion for ourselves in these troubled times? How can we engage in a self-nurse-care practice that is more than a mani/pedi? Or a glass of wine? Or massage? Is it wrong to judge those activities as though they are not good enough? What if that is all we have, at the moment, that we can wrap our heads around to even begin to allow for ourselves? How do we separate ourselves from our patients – meaning that we are not owning their journey? That we are not responsible for their ultimate happiness or life? That we can partner, walk with, and not carry? How can we respect ourselves for doing enough by bearing witness? 

As nurses, we are educated and trained to have the knowledge , skills and abilities that others may not have to help them live their best or healthiest life. As we coach our patients on healthy lifestyle needs and behaviors, we may own their accountability. Meaning, that we are taking the brunt of the personal choices our patients make in this moment. This feels like caring, to want health for someone so much that we are willing to own it for them. When the patient makes an inadequate or harmful healthcare decision, then we may take the blame, we may own the outcome, we may feel inadequate or inept. We may also blame the patient for “making us feel that way”. This is a wound. 

Self-nursing asks us to take a closer look at that situation. When we assess our patient, we are also assessing their readiness for behavioral change. As we do that, in this scenario, we must also assess our readiness to meet this patient where they are at in this moment. When we can accept the choice that the patient makes, provide them information about the consequences and recognize them as a person with freedoms, we are actually “letting them go” to be themselves. By not owning the outcome for a person’s health behavior choice, we are forgiving them, “letting them go”, for our own response to their choice.  

When there is turmoil in a relationship, it is easy to point to the other person as the one that doesn’t step up or isn’t living up to expectations. We can often get caught up in the idea that others are to blame and that I personally have no control over this. What does that mean in terms of forgiveness? There is the transgressed and the transgressor. There is the sense of someone at fault and someone at the mercy of the other. This situation set ups the same cycle of recognizing that an expectation is not being met, the assessment of whether that expectation is real or a hill to die on, the opportunity to gain mind, body, spirit control over that expectation and the reality. To balance the table so to speak. And then to choose or make a decision of what you will do next. 

We face difficult situations as nurses, both in caring for patients and their families as well as bearing witness to their lives. Often, we talk about how this affects us, specifically from a stress and coping perspective. A lot of attention has been paid to the effect of stress in nurses that results in burnout, compassion fatigue, and now, more than ever, moral injury/distress. One thing that happens is that “alone feeling” when faced with situations that create these stressors. In situations that trigger the heart of us – our values, our moral beliefs, our ethical standards – it can become difficult to carry on when we must compromise our heart for the greater good. We may feel shame, guilt, distrust in ourselves or others. A sense of carrying the weight of an event and adding the weight of existential crisis. Other symptoms may arise like changes in mental well-being, relationship health, and ultimately self-harm. There are life events that can impact the body, mind, and spirit of a person. These are very complex situations that deserve deep and thorough evaluation of the event and the self. These generally require professional support for fullest healing.  

What forgiveness is not. Forgiveness is not justice. Forgiveness is an internal action that can impact personal wellbeing. The benefit goes to the person themself that feels of transgression, being used, victimized, bullied, affronted, and things like that. Justice is the external action of matching fair treatment. Where there is balance and equality.  

Forgiveness is not forgetting. It does not mean that by forgiving the actions of the other are condoned or excused. The transgression is still there, what is not there is the attachment to the feeling associated with that transgression. It does not mean that a relationship changes between the transgressor and the transgressed. It does mean that the transgressed moves on in life – with feeling of peace, and maybe understanding, empathy and compassion for the transgressor. But that is not required. The forgiver feels peace and is no longer caught in that web.  

Taking compassionate action through forgiveness might not be easy. It means assessing self in the stressor – what has this stress triggered in me that I need to pay attention to? Is this something that I choose to have in my life? Is this something that I have control of? It means looking at the stress trigger – what is it about this event, situation, conversation that leaves me feeling this way? Forgiveness happens when the wounded lets go of the wounder/wound. The emotional bond is no longer a bond that holds the wounded in a static space, hindered from caring, relationship, and compassionate action. Self-forgiveness is part of the caring relationship each nurse can have with self. As we assess our health and well-being, we can investigate what has a hold on us that creates stress, low energy, depressed thought, and anxiety. What is the wound? If we sense that we are “burned out” or feel like we suffer from “compassion fatigue” the opportunity to self-assess what causes that is an opportunity to self-nurse.  

References 

Cao W, van der Wal RC, Taris TW. When work relationships matter: Interpersonal forgiveness and work outcomes. International Journal of Stress Management. 2021:1-17. doi: 10.1037/str0000192. Accessed December 1, 2021. 

Malone A, Meyer DD, Tarlton T, et al. The relationship between forgiveness and emotional well-being. American Counseling Association, http://counselingoutfitters.com/vistas/vistas11/Article_23.pdf. Accessed December 2, 2021. 

Norman K. Forgiveness: How it manifests in our health, well-being, and longevity. [Master Capstone]. Philadelphia, PA: University of Pennsylvania; 2017. 

Schumann K, Walton GM. Rehumanizing the self after victimization: the roles of forgiveness versus revenge. Journal of Personality and Social Psychology. 2021:1-24. doi:10.1037/pspi0000367. Accessed December 1, 2021. 

Dr. Amy E. Rettig provides nursing care for both professional and non-professional caregivers. She presents, publishes and studies well-being (developing the caregiver within) from the perspectives of holism, caring relationships, and systems.