https://www.infirmiere-canadienne.com/blogs/ic-contenu/2025/12/01/jaimais-etre-infirmiere-praticienne-mais
How self-reflection could be key to your happiness as a nurse
istockphoto.com/Jacob Wackerhausen
There has been a great deal of literature that has explored moral distress and burnout within the discipline of advanced practice nursing.
I share my story not to dwell on past difficulties or talk about burnout and moral injury, which has already been discussed at length over the past few years. Instead, I want my story to remind all nurses that our core ethics are really at the heart of everything we do — not just the skills we deploy, the tasks we complete, and the shifts we cover. If you’re feeling overwhelmed like I was, I hope my article helps you gain a bit of perspective and inspires you to adapt.
Busy practice with roster of 700 patients
It was early spring 2023. I looked at myself in the mirror on a Wednesday morning as I prepared for the workday while simultaneously attempting to get my children ready for school and daycare.
At the time, I was practising as a full-time nurse practitioner in rural Nova Scotia, with a panel of 700 patients. I literally said to myself, “Who is this person looking back at me?” I was exhausted, physically, mentally and emotionally. I had woken through the night thinking about the referral letter that I had sent for a patient the day before, and wondered if it would be accepted by the specialist. I’d written to four specialists that week, and all but one rejected the referral or suggested it be re-directed to another colleague. The one who accepted advised it was a three-year wait to be assessed.
I was an advanced practice nurse, and I valued and prided myself on the relationships I built with patients. I was focused on being their primary care provider, which also meant I was their advocate, care coordinator, system navigator and follow-up NP extraordinaire. The system was swamped then, and it is still today. Accessing an appointment with me felt like forever, which frustrated me and my patients alike.
The expectations for myself and my role felt blurry.
Offer same day and next day appointment availability; see booked patients; be available for our nursing colleagues when needed; follow up on your investigations; constantly check that your referrals to specialists have been followed up; complete all the charting; take allotted breaks; don’t work overtime; preceptor students — and the list just went on, and on, and on. It felt like there wasn’t enough time to collaborate properly or reference something in the medical literature. And if you had to take a call from a colleague, it was difficult to get back on schedule for the rest of the day.
Couldn’t keep up
I truly felt like I couldn’t go any faster. I felt like I couldn’t keep up on the lab results, tasks, and incoming reports that had multiple suggestions and recommendations for me to implement, assess and evaluate. I was committed to the importance of establishing and maintaining high-quality therapeutic relationships with my patients and their families. I loved this part of my job, but it took time. It meant listening to patients’ concerns, health issues and frustrations. It took time when the patient was in my office, sitting in front of me, and it often took time charting and advocating for them on the back end of things.
My experience is certainly not unique. There has been a great deal of literature that has explored moral distress and burnout within the discipline of advanced practice nursing. Researchers have found, for example, that time pressure and heavy workloads are associated with emotional exhaution, cynicism, pessimism, and a dispassionate and disconnected reaction to patients and colleagues (Dall'Ora, Ball, Reinius & Griffiths, 2020; Heale, 2025).
I have also learned that many nurses can feel that their values of providing care conflict with the values that prioritize expediency, which plays a driving force in burnout within nursing, I suspect I too was struggling with this (Dall'Ora et al., 2020). Did you know that NPs who frequently stay late to complete unfinished work are 20 times more likely to experience burnout (Heale, 2025)?
Still to this day, I believe that to truly understand the interconnectedness of patients’ health and wellness concerns, I must listen. One must listen to the story, ask the right questions, and devote the right amount of time. I always found that through listening, the patient and I could develop a plan that accurately prioritized their concerns and my concerns within the limitations of the health-care system. But once again this took time. Time that I felt like I didn’t have, but needed to take for my patients. I knew my patients were waiting weeks to see me, and sometimes over a month, but I knew when they were with me, it was their time. Their time to be cared for, to be heard.
Over my 12 years of nursing, I’d been told more than once, “you care too much.” Could this really be my problem? And not a time problem?
The role of self-reflection and ethics
Self-reflection has always been integral to my nursing practice. I strive to place nursing ethics front and centre. I strive to provide safe, compassionate, competent and ethical care; promote health and well-being; respect informed decision-making; honour dignity; maintain privacy and confidentiality; promoting justice; and be accountable. But I couldn’t help but wonder: is it all just too much?
I often reflect on Swanson’s theory of caring, which for me raises the question of caring for versus caring about. Do the two need to be in tandem to truly guide wellness and support healing? For me, it always felt it was necessary to do both. My authentic self can’t accept less.
If I had to miss a day of work, it meant patients waited even longer to see me. The incoming labs and paperwork also kept coming, meaning it would be twice as much the next time I was on shift. Sometimes I didn’t even want to take more than a few days off in a row, because it didn’t feel like it was worth it; I’d arrive back the next shift and was slammed. I was jumping on the computer in the evenings and on days off, sometimes calling patients with results that I knew I wouldn’t have time to deal with during a busy clinic day.
My soul hurt. My spirit hurt. I sincerely felt like the care my patients needed was out of my reach. The care I expected myself to provide — morally, ethically and professionally — felt out of reach.
Like many health-care professionals across the globe, leaving my current position or reducing my working hours seemed like the only answer (Baugh,Takayesu, White & Raja, 2020). I had to decide to do something else. I had to leave direct patient care full time.
Finding balance that was right for me
Looking back, the care I provided was indeed ethical, safe, compassionate, and just, but it felt like I was personally taking the brunt of the storm. In late summer 2024, I was granted a leave of absence from my full-time primary care practice and accepted a position in clinical education.
It’s been over a year since I was in clinical practice on a full-time basis. I continue to practise casually as a nurse practitioner to maintain my competencies. I continue to have mixed emotions about the change; however, I believe my spirit is recovering, and my passion for nursing, leading and healing remains strong. I continue to reflect on the Code of Ethics, and I hope all nurses are weathering the storm in their own ways.
Interestingly, in my clinical educator role, I was provided an opportunity to be sponsored as a student in the holistic nurse coach program offered by the Canadian Institute of Integrative Nursing Development and Education (CIINDE). The program has been integral in learning about my values, beliefs, and the importance of self-care. It’s helped me understand my own nursing journey. I have gained skills in nurse coaching, which are deeply embedded in my practice of nursing, in both my direct patient care roles and in clinical education supporting nurses through their own practice journeys.
Call it burnout or moral distress. Call it exhaustion. For me, it meant realizing that my family, health, and having balance in my life are the most important. Working full-time as an NP clearly wasn’t the right position for me at that time in my life. But maybe it will be in the future.
If you’re feeling overwhelmed, remember that being a nurse is a journey. Take the time you need to find the right path for you.
References
Baugh, J. J., Takayesu, J. K., White, B. A., & Raja, A. S. (2020). Beyond the Maslach burnout inventory: addressing emergency medicine burnout with Maslach's full theory. Journal of the American College of Emergency Physicians Open, 1(5), 1044-1049. https://doi.org/10.1002/emp2.12101
Dall'Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human resources for health, 18(1), 41. https://doi.org/10.1186/s12960-020-00469-9
Heale, R. (2025). Exploring prevalence and implications of burnout among nurse practitioners in Canada. European Scientific Journal, ESJ, 37, 391. https://eujournal.org/index.php/esj/article/view/19037
Santina Weatherby, MN, NP, CDE, is a nurse practitioner clinical educator with Nova Scotia Health.
#opinions
#career-stage
#covid-19
#interprofessional-collaboration
#intra-professional-collaboration
#nurses-health-and-well-being