Paving the Way: Diminishing “Transition Guilt” and Reconsidering Nursing’s Future

By Christine C. Roberts MSN, RN, PCCN

When the novel coronavirus became a pandemic, it forever changed our world. Almost overnight, we were all forced to endure change, scarcities and adversity in order to protect our families, livelihood and society. Humanity came together to support those in need, protect others and provide assistance.

I have always been proud to be a nurse and the outbreak of COVID-19 only heightened my admiration of the nursing profession. Bedside nurses and health care workers were at the front lines working tirelessly and selflessly, without the traditional evidence-based safeguards, to care for the sick and make a difference. So many people have expressed an outpouring of gratitude and support for our frontline health care workers, and for this I feel very humbled and thankful.

My primary role in the nursing profession is as a clinical instructor. I am still at the bedside at a local hospital, but very sparingly due to numerous obligations. I am proud to share my nursing passion and skills with students eagerly transitioning into nurses. I know what I do as a nurse educator is valuable, important and my future.

Why then, have I continually felt guilt at the thought of leaving the bedside?

This is a question I have asked myself for years and a guilt that I have felt since finding my calling in academia. I have discussed this “transition guilt” with colleagues both at the bedside and within educational settings in an attempt to decrease these feelings. When COVID-19 forced societal lockdowns and changes in our work modalities, I found myself struggling, as many did, with the physical and emotional strain of so much change. In the midst of trying to cope with so many lifestyle changes, I was not able to work as a bedside nurse, which, in turn, heightened my feelings of guilt.

I cannot begin to describe the dichotomy of feelings during the last few months: such pride in being a nurse, but such guilt at not being able to work at the bedside. It was as if there was a war raging between my heart and my mind: one rational and one very emotional. It was akin to having an “angel” on one shoulder reminding me that I was still a nurse, and I was doing wonderful things to promote my students’ learning and uplift their spirits, but a “devil” on the other side making me feel unworthy to call myself a nurse because I was not at the bedside providing direct care. Social media helped to fuel this “war” as I was constantly reminded of the wonderful sacrifices the nurses were making at the bedside. These touching images shared through online and television outlets only fueled my guilt.

As time went on, I realized I had to work through and overcome these feelings of guilt, as they were causing me to be depressed and socially withdrawn. I had to accept that I was not perfect and could not be everything to everyone. I was doing my best and that was okay. Around mid-May, I began to feel better about myself and did not feel depressingly guilty about not being able to work at the bedside. However, while the guilt was less, it was not gone, and I had begun to wonder:

• Do other nurses have “transition guilt” when moving from away from direct bedside care?
• How many other nurses feel guilty about not being at the bedside during the COVID-19 crisis?

How can I contribute to support my fellow nurses?

In July, I was finally able to devote some time to working within the hospital. Many changes had taken place since the emergence of COVID-19 and when I had last worked at the bedside. I was not familiar with the new routine, procedures, electronic health record and equipment that had been implemented in my absence. But I knew that I wanted to help during this time of crisis.

While I was not able contribute as a bedside nurse, I was able to help in other ways. I worked in pre-admit testing by helping to perform COVID-19 nasal swabs, complete 12-lead EKGs and prepare patients for upcoming surgeries and procedures. Even though this was not my traditional role as a critical care bedside nurse, it was still nursing and I was able to care for patients, ease the burden on fellow nurses and assist my health care system.

Once I began working within the hospital setting with patients again, the feelings of guilt and depression decreased, and I felt as though I was finally making a contribution. I was able to continue helping in this role until the fall term began and then had resign from my health care system because I was unable to meet the minimum shift requirements. Although it has taken me six years, I am now more comfortable with my decision to transition fully into academia. However, I have begun to wonder:

Why are nurses compartmentalized into only bedside or administration within direct-care settings?

At this time, many health care systems continue the tradition of compartmentalizing nurses into either an administrative or bedside role. I believe the COVID-19 pandemic has shown that nurses can be so much more. Those of us who are no longer at the bedside can still contribute — measuring vital signs, helping with basic patient care, performing nasal swabs, drawing labs and just being an extra pair of hands are what we have all been trained to do as nurses.

Instead of requiring nurses to fit the traditional bedside or administrative mold within hospitals, why not also realize our continued worth as a “nursing reserve” that can mobilize and assist when needed? Nurses are trained and expected to assess, assist and provide care to anyone, anywhere and at any time — regardless of our title or role within the nursing profession. I believe nurses can and want the opportunity to assist within the direct-care settings, but the ability to do so is limited for so many reasons: scheduling demands, competency and role requirements and limited role options.

I have seen much support for nurses on the front lines, but what of the ones that are not able to work at the bedside and as a result are feeling guilt, remorse or shame? Reach out to all nurses and ask: “How are you?” Reassure them of their value and contributions to the profession. Support nurses transitioning into new roles that may be feeling guilty or conflicted about leaving direct care. Encourage health care systems to see the value in utilizing nurses outside of the traditional “bedside” role and that we can and do want to continue to contribute!

We need to consider a “Nursing Reserves” within our profession so that we may be called upon to help in times of need — even if our role is limited, we can still help. All nurses are a part of our nursing family. We need to support each other, for we are all one profession working together to pave the way through our current and future life transitions.