The Joy of Nursing

ASHLEY: I’d like to start this conversation by hearing what the phrase “joy of nursing” means to each of you. Laura, can you start—and, please, let’s use first names.

LAURA: Sure. There are two aspects of it for me. One is mentoring new nurses—seeing students and novice nurses go on and do great things, achieve what they wanted to. That gives me great joy.

The second is connecting with patients. I still work clinically, delivering anesthesia one day a week, and the days I take care of patients remind me why I do this. Recently, we had a 3-year-old whom escort services couldn’t get to the OR in time, so I brought her down for her procedure. This little 3-year-old radiated joy as we walked along and looked at paintings in the hallways. It reminded me of the simple things in life, as well as what a privilege it is to care for patients and see them through hard times. That’s why I became a nurse. 

ASHLEY: Thank you, Laura. Felesia, what does “joy of nursing” mean to you? 

FELESIA: I’d like to start by defining joy. To me, joy is different from happiness. I can be not happy but still feel joy. It’s a spiritual feeling, a sense of peace, no matter what’s going on around me. It’s a settling sense that keeps me grounded.

So when I think about joy in nursing, no matter how bad a day is, no matter how many fires have to be put out, I know I’m in the right place. 

ASHLEY: I never considered differentiating joy and happiness—that’s powerful. Thank you, Felesia. Kevin, how about you?

KEVIN: For me, “joy of nursing” means the impact I have on another person and the impact that person has on me. When I insert myself into their story, into what I call “sacred space,” it’s a powerful moment. Being with that person and that family gives me deep satisfaction—even if I don’t know them and they don’t know me, even if the outcome isn’t what we hoped for. 

Like Laura, I still practice in addition to serving as chief nurse. I was in Labor and Delivery recently, helping deliver a newborn. As I watched the nursing team supporting this tiny baby, the feelings I had in nursing school came flooding back. It was a difficult delivery, but I felt joy as I watched my colleagues around his bassinette, supporting him as he struggled to take his first breath. When we heard his little cry, it was truly joyous.

ASHLEY: That’s beautiful. 

PAUL: I think if you keep in mind the purpose behind what you do, assuming that purpose is fulfilling to you, then you’ll experience joy. For me, the joy of nursing means remembering why I chose to be a nurse. 
I’m so glad we’re having this conversation, because I don’t think we talk about such feelings enough. Weeks go by without my saying, or hearing someone else say, what we’ve just said out loud.

Maybe that’s why we’re not experiencing as much joy in health care nowadays. So let’s take any opportunity we get to say it out loud—that we could help another person.

ASHLEY: Well put, Paul. I’m wondering if, over the course of your career, your sense of joy has taken different forms? 

PAUL: That’s a great question. It makes me think of Maslow’s hierarchy of needs, which we all studied in school. In other words, if you don’t have enough food, it’s tough to seek joy; overcoming your physical need has to take priority. 

I had a stroke early in my career and had to learn to walk and talk again. Everything I did was focused on overcoming those deficits in the hope of someday finding joy again, as opposed to seeking joy in the moment. It’s like joy was something I’d get later if I tended to my immediate needs.

ASHLEY: Thank you for sharing that, Paul. I’m sure it helps you see the patient perspective. Felesia, how about you—any shifts in how you’ve experienced joy? 

FELESIA: Absolutely. I live in Birmingham, Alabama, a city where parts are flourishing—but in other parts, people struggle economically. My joy comes from going into those communities, working with children there, putting together programs to support them. 

We recently signed an agreement with the Birmingham schools to build a pathway-to-nursing program. It took a lot of sweat but brought me considerable joy. So even when I’m not having the best day, I know I’m where I’m supposed to be, which gives me joy. 

But when I was in school and first working as a nurse, if I wasn’t having a thoroughly good day it felt like a bad day. But my perspective changed when I was deployed in the first Persian Gulf War. I hadn’t even been a nurse a year and was going to this place of uncertainty, unsure if I’d make it back. Being exposed to all that emotion—and, as Kevin said, being inserted into people’s lives, willingly or not—if I could have gotten on a plane and gone home, I would have.

So I decided I had to find some meaning in each day or I’d lose my sanity. And I realized I didn’t need to be “tee-hee” happy all the time. Happiness, I learned, is transient. But joy stays with you, no matter your situation. That understanding was life-changing. 

LAURA: I hear you, Felesia. Early on, I was a little selfish. I wanted to accomplish things for myself: be an ICU nurse, go to CRNA school, do X and Y and Z. But as I’ve grown in my career, my goals and sources of joy have changed from being focused on myself to being more focused on others. 

Now, when I see former students or former colleagues and am reminded of the hand I had in helping other people accomplish things, I feel a tremendous amount of joy. Even something simple like talking to my kid’s class about the human body gives me joy, to know I can take knowledge I’ve learned, simplify it, and share it with first-graders. Cultivating and nurturing all these relationships gives me profound joy. 
 

PAUL: Something that’s shifted for me is I no longer feel I need to escape tough times. I try to enjoy each day for what it is—be fully present, whether I’m at work with my team or at home with my wife and son. I try to make whatever room I’m in a better room for everyone else in it, not necessarily for me. I think a lot of people who feel burned out are seeking to escape from that feeling. But that means you’re pushing joy off to the future and not experiencing the present. 

That’s not to negate that health care has issues, of course: staffing ratios, documentation, and so on. But if we’re always pushing joy into the future, we’ll never find it.
 

KEVIN: What’s shifted for me is that as I’ve moved further from the bedside, I’ve struggled with maintaining a sense of purpose, a sense of having an impact on others. Yes, I’m leading a thousand-plus nurses, but how do I stay energized and find the feeling you get at a patient’s bedside?

So, like Laura, I focus on the next generation of nurses: nurturing their desire to join the profession, fostering their passion for helping people, modeling how to feel joy. That’s what sustains me now. We need to make sure the new generation of nurses finds the kind of joy that will keep their passion ignited, so they’ll want to walk across the threshold each day and care for other people.

ASHLEY: Are there things you feel get in the way of finding joy? 

PAUL: I think a big one is we don’t say it’s a priority. If you ask the leadership of any hospital in America, “What are your institution’s priorities?” they’ll list safe patient care, outcomes improvement,  through-put, and so on. I don’t think anyone would mention joy. But joy should be at the top of the list—well, maybe safety, then joy. 

If you don’t say joy is a priority, those other things take precedence unless someone raises their hand and asks, “Hey, what about joy? Is that a priority?” Then everyone goes, “Yeah, of course,” like it’s understood. But we have to say it’s a priority for it to stick.

And if no one’s having fun doing this work, no one will want to do it, and then there’ll be no one to do it. So, really, it’s the most important thing. 

ASHLEY: Exactly. The nursing shortage is persisting, even though nurses today make a good salary, largely due to the discontentment experienced by many nurses. So how can nursing leadership keep staff inspired and engaged?

PAUL: One thing I do is make an effort to know the name of every person who reports to me and a fact about them. I try to pick something that brings them joy: their child’s name, their new puppy, whatever lights them up. 

Then when I see them, I say, “How’s your kid?” or “How’s your dog?” Other people on my team have started doing it, too. Then, even if it’s not a good day, you’re working with a team that cares about each other, so joy—or at least a sense of belonging that may lead to joy—is there somewhere.

ASHLEY: That’s great. 

PAUL: I don’t think a “Here’s a slice of pizza” gesture makes a nurse feel genuinely cared for. But “Tell me about your family” shows you care about them as a person. 

FELESIA: I think level of leadership matters. Top-level leaders understand the importance of nurturing. But someone working on the floor doesn’t see them every day; they see a charge nurse who may or may not be skilled. 

I think that’s where professional development should be focused—on that first level of leadership, because immediate supervisors are the ones who determine if a floor nurse has a good day or a terrible day.

KEVIN: I agree that the relationships you cultivate with your staff are key. Just like Paul, I make a point of knowing something about everyone on my team. So I can say “Hey, how’s the new house?” or “How’s the family?” or whatever—some way to connect with them, so they feel seen. 

If leaders see staff, then staff feel seen and valued and respected. I don’t know if that alone cultivates joy, but it helps. 

LAURA: I think nurse managers and preceptors typically don’t get enough support for the important role they play in mentoring frontline staff. They’re the glue that holds it all together. But they’re not trained appropriately, they’re pulled in a thousand directions, and they’re responsible for so much—quality metrics, financial metrics, and so on. 

I worry about them, to be honest. It’s hard to be a manager—to be open and honest, to listen to your staff, to take calls at 9:00 at night and on weekends, to remember a fact about everybody who works for you. Being a middle manager is the worst—you get it from the top and the bottom. Yet the success of each new generation of nurses is dependent on the nurse managers and preceptors, so we need to take care of them. 

FELESIA: That’s exactly right. 

KEVIN: Laura, spot-on. Too often, they’re coping on their own. 

I think the visibility of senior leadership is important, so frontline managers feel connected to someone who supports them and values them. It’s a hard job. Most businesses don’t have managers with 100 direct reports, like nursing does.

So how does a nurse manager maintain joy amidst the day-to-day chaos, the average daily census, the churn, the smattering of other tasks, the staff complaints, who doesn’t want to work with who—it’s so much to juggle. They’re like Wallendas on the high wire. 

ASHLEY: Great points, everyone. That leads me to ask about a word we’re hearing a lot: “burnout.” Thoughts? 

LAURA: I actually think the word “burnout” should be removed from the lexicon. In every field, there’s some fatigue, some burnout—it’s not unique to health care. Maybe health care talks about it more, but people are feeling pressure in industry after industry. 

I think what we need to do is find what gives each of us joy. Maybe it’s nursing, maybe it’s family or a hobby, but whatever it is we have to find it. In some metropolitan areas, people work 100 hours a week because they value money and want to live well, and if that’s what they want, that’s fine. But for some of those people, maybe it’s not what they really want. You have to take stock of what you value, so you can prioritize it.

PAUL: I agree. It gets to Felesia’s point about when she was in the military. If you’re in a period of struggle and are seeking only to escape it—to get out of the war zone, to go home at the end of the day, whatever—that day never comes. We need to find joy during a struggle. 

LAURA: I will say, and I’m making a generalization here, I feel that bad days used to be few and far between. But now much of our workforce feels like every day is a bad day, like they can’t catch their breath. Some places are in a vicious cycle of staffing shortages. 

KEVIN: True—and I would say that’s when the term burnout actually applies. When you have consistent understaffing, consistent disrespect, consistent devaluing of nurses—then I understand the concept of burnout. 

ASHLEY: Felesia, I’d like to hear what you have to say on this point. 

FELESIA: You know, it reminds me of when kids say, “I’m starving.” My response is, “No, you’re not. Starvation is a metabolic state. You’re just hungry or maybe bored, but you’re not starving.” I think that’s what burnout has become. Often, nurses are just tired. Or annoyed because someone disrespected them. Or upset because they had to empty the trash. 

Of course, nurses on the front lines during the pandemic—I get that they burned out. Nobody trained them to see so many people die, to see bodies piling up; that’s not normal.

In most situations, though, I feel it’s not my employer’s responsibility to make me happy. We’re big kids. We’ve got to decide what we want, slow down and do some reflection. Reflection is part of professionalism. 

PAUL: Exactly. I trained in palliative care at Columbia; the program was formative for me, because I saw things clinically that couldn’t be fixed and still witnessed people experiencing joy. 

I think if we just pause for a second, the way one does on a palliative care unit, we’ll find joy. But our health care system doesn’t allow pauses.

ASHLEY: So true. I’d like to ask next who first opened your eyes to the joy of nursing? Mine was my nurse manager, who always kept an extra pair of scrubs in her locker. When things got tough, she donned them and came onto the unit with us. I saw that with my CNO, too. Who introduced each of you to the joy of nursing? 

LAURA: One of mine was my first nurse manager, on the thoracic unit at Sloan Kettering. I didn’t get how chest tubes worked. I’d studied them in school but didn’t understand the chamber—it was like gobbledygook. So I went to her, and she sat down in the middle of her busy day, took out a piece of paper, drew me a picture, and talked me through it. I was like, “Wow!” Before that, I’d thought she was a little scary. But she took the time to answer my question. That was profound for me.

KEVIN: For me, it was two women I worked with as night nurses on a vascular floor at NewYork-Cornell Medical Center. All three of us had just graduated, yet what we cultivated as brand-new nurses was nothing short of amazing. We didn’t really know what we were doing, but we relied on each other so much that it was a joyful time in my life. I knew I’d found my calling. 

FELESIA: One of mine was a patient, a little girl, when I was still in nursing school. She lived in rural Alabama and had been badly burned when her nightgown caught fire. She’d been in the hospital a long time.

My job was to get her ready to go home. She still had some graft patches, but her grandma was picking her up that day. I brought her into the bathroom, and as I watched her brush her teeth—dipping the brush in the water, then turning it off—and use the toilet—not flushing—I suspected, from having visited my grandparents, who were very poor, that this little girl’s family had no indoor plumbing. I knew she shouldn’t go home yet. 

I explained this to my instructor. She talked to the little girl and found that indeed her family had no running water. So her discharge was canceled, until social work could find a place where her grandma could take proper care of her. I was like, “Wow, I made a difference.” I might have saved that little girl’s life—kept her grafts from getting infected. I knew I was in the right spot.

Another was in the Army—a lieutenant colonel in her Class B uniform. We called nurses like her “clipboard carriers,” because they just went around and checked on things. One day we were getting slammed on the unit. She came in and said, “What do you need me to do?” We just stared at her, so she went on, “I’m not passing meds or hanging IVs because I’ll kill somebody, but I can take op orders, change beds, answer phones.” And this lieutenant colonel changed beds, emptied bedpans, and delivered trays. I would have walked through fire for that woman. To me, she was a quintessential leader. Nothing was beneath her if it helped us. From that moment on, I’ve tried to be that type of leader. 

LAURA: My influential nurse was when I was a patient. I’d just had twins and worked right across the street, so everybody wanted to visit me. I’d had a C-section and hadn’t taken my pain meds all day, so by 7:00 p.m. I was almost delirious.

The day nurse hadn’t paid much attention to me. She just watched my friends coming and going, like Grand Central Station.

Then the night nurse came in. She looked at me and said, “You need to rest. The rest of you, get out so she can recover.” I was so grateful somebody was looking out for me. It took a seasoned nurse to assess the situation and say, “Your priorities are wrong. Get your visitors out of here, take your pain medicine, and get better.”

KEVIN: I had a similar experience. I was really sick with COVID in 2020, and one day I became clinically unstable. Amidst the chaos, one nurse kept saying, “I’ll stay with you, Kevin.” She stayed with me until I got back to the ICU; she focused on me while everybody else worked around me. It was remarkable nursing care. Being the recipient of joyful, deliberate practice is extraordinary. 

ASHLEY: Those are powerful stories—thank you, all.

LAURA: Not to state the obvious, but this conversation has been a truly joyful experience. 

ASHLEY: I agree, Laura. You’ve all been so eloquent about why we do what we do. 

PAUL: The problem with feeling joy is sometimes you think, “Am I the only person who feels this way?” It’s like you’re in a twilight zone. But as I hear the rest of you talking, I know I’m not alone, and that gives me joy. So, thank you!

KEVIN: I agree. I’d love to leave you with a quote. It’s by Martha Rogers [of NYU]. In 1966, she wrote: “Nursing’s story is a magnificent epic of service to mankind. It is about people: how they are born and live and die; in health and in sickness; in joy and in sorrow. Its mission is the translation of knowledge into human service. Nursing is compassionate concern for human beings. It is the heart that understands and the hand that soothes. It is the intellect that synthesizes many learnings into meaningful administrations.” 

I read this quote every day, because it grounds me and reminds me of the important work we do each and every day. 

ASHLEY: What a perfect coda to this conversation. Thank you, all.

Illustration by Luisa Jung.

This article originally appeared in the Spring 2024 issue of Columbia Nursing Magazine.