I have been a cancer nurse for more than 40 years. Over these 40 years, I have witnessed dramatic changes in the diagnostic and treatment advances of patients with cancer. Despite these advances, a cancer diagnosis remains a very personal and potentially traumatic experience for patients and families. Statistically, we know that many of these people do well and return to productive lives. Although the numbers of people surviving cancer grow each year, as nurses, we rarely see our patients fully functioning. In contrast, we care for patients during periods of increasing dependency, high stress, and symptomatic crises. During these times, by the nature of our work with patients, trusting relationships evolve that include intimacy, presence, and kindness. We are responsible for their care, providing safe and evidence-based practice. In fulfilling our responsibilities, our days and nights are filled with a continuous flow of symptomatic ill patients who cross our paths and travel on or who die on our watch. The patients who give us our most challenging experiences are also the ones who weigh most heavily on our hearts.

Early in my cancer nursing career, I learned at St. Christopher's Hospice how important it is to have a safe environment to debrief regularly about our experiences-a safe place to cry, laugh, express regrets, and share our successes. There, the staff psychiatrist, Dr Colin Murray-Parkes, met with us weekly to debrief about what we were experiencing and to offer support.1 I saw firsthand the benefits of having a conversation with a skilled clinician whose sole purpose was to help me express my feelings. Debriefing is a term used to describe structured support where conversations are facilitated to reduce the possibility of psychological harm by informing the participants about their experience or allowing them to talk about it.2

From a psychological standpoint, the aim is to prevent psychological morbidity, posttraumatic stress disorder, and other related anxiety disorders. Often, nurses talk with me about their personal accounts of losing patients, stories of perceived personal failing, and stories about not being heard and about witnessing conflict because of differences in physician-patient goals. More recently, those conversations have included complaints about the work environment and the demands of the job. The accumulation of caring for very ill patients in nonsupportive environments without opportunities to debrief can only lead to poor outcomes for both patients and nurses. Some of these nurses make the ultimate sacrifice of leaving the profession when they feel they are no longer effective in making a difference. Melvin3 describes the heavy toll that professional compassion fatigue has on nurses as they experience the continued loss of patients. Many nurses go about their days experiencing increased stress with little understanding as to what is happening to them until they become ill, numb, or despondent.

Today more than ever, in our increasingly demanding healthcare environment, we need to be proactive and take responsibility to ensure that we have structured interventions to care for nurses to ensure that we can continue to care for others. We now know there are many effective ways of revitalizing ourselves such as regular exercise, yoga, meditation, healthy nutrition, and journaling. Most of these interventions are geared toward taking personal responsibility and doing things for ourselves by our self. However, I encourage you to also find ways to share with your coworkers because of the commitment you have as a team at your work. There is a substantial amount of evidence to guide our care of symptomatic patients today, but there is less known about how to help environments nurture their staff and feel good about what they do on a daily basis.4 If your own work place does not provide regular debriefing opportunities, I encourage you to form a group with your peers to share your stories, both the successes and the heartbreaking ones. You can ask the hospital chaplain, social worker, or psychologist to facilitate the group. Throughout my career, my patients have remained my best teachers and nurses have remained the best problem solvers. It is important to verbalize what we learn from our patients and from each other so we can reinforce the strategies that work and change the ones that do not. Most importantly, our lives must include opportunities for humor along with sharing. Some of the best therapy comes from laughing with each other and at oneself.

As cancer nurses, we know what a true privilege it is to be in the presence of our patients and to help them to experience their cancer journey the best we can make it. We need to share our tears with each other. Those of us who have lost patients are held together by a common bond. It is through this sharing that we will continue to be able to care for our patients over the long haul. Debriefing will allow us to gain insight into our experiences, and through that insight, we can remain healthy and continue to nurse others.

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