One afternoon in nursing school, I remember a professor spending nearly an hour exploring the difference between sympathy and empathy. To me, the inexperienced novice, those words were the same—synonyms, surely, both meaning some form of caring. But in reality, as many nurses know, these two words mean very different emotions.

So what is the difference? The video below, an illustrated cartoon to the words of Brené Brown, is my favorite demonstration of the meaning of empathy.


For me, in nursing practice, sympathy is easy. It’s an, “Oh, I hope you feel better,” or “I’m sorry you’re hurting.” Empathy, though? Empathy is hard. It can be very uncomfortable to relate to patients in that way, and it can make it difficult to place boundaries around our work. Ask any nurse—a vocation often characterized by our ability to be caring—this career wouldn’t be possible if we weren’t able to construct empathetic boundaries.

I’m guilty of sympathy—I catch myself of wanting to comfort with an “at least…” or of “silver-lining it,” as Brown describes in the video. Especially in emergency nursing, it’s easy for the cynic within us to put up walls. But just as there is a difference between sympathy and empathy, there’s a difference between a boundary and a wall. Walls keep others out, whereas boundaries are erected to keep parts of us safe.

When other people are in emotional agony it can be uncomfortable to witness. It is frankly a mechanism of survival to place boundaries between us and our patients. Too much empathy and we would not be able to carry on from patient to patient, to think critically and rationally, to be cool or level-headed in a crisis. Too much empathy, and my game face dissolves. Treating every patient as if they were part of my own family would very simply be the end of my ability to do my job at all.

That’s where the boundaries come in. Nursing is a careful balance of caring the exact right amount for each patient so that we can easily move from room to room. Each of us has to be able to get close, but not too close, to our patients and their families. For some of us, that simply means remembering that the patient is someone’s mother, grandfather, sister, friend. For others, it’s remembering how scary it can feel to be in a hospital at all. As the video above shows, we as nurses have to be able to crawl down into the proverbial hole with our patients, to understand—truly—their pain and their feelings, but we very quickly must crawl back out on the other side. Because in the room next door, another patient and another hole are waiting.

It’s never easy. Sometimes, no matter how hard I try, I just can’t leave the patients at work. I’ll cry for them in the car driving home after a shift, or I’ll pray for them before bed. It’s comforting, in a way, as that tells me that I’m caring just the right amount. It’s impossible not to be touched by the stories we hear and the people we meet. I think empathetic boundaries allow us care more, to be more present with patients and their pain, and most importantly, to take better care of ourselves. When we take better care of ourselves, we can draw more readily from our reserves—we can more swiftly crawl back out of the hole. This makes all the difference when taking care of others.

Laura Kinsella

Laura Kinsella, BSN, RN, CEN, is an emergency room nurse in Washington, DC.

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