Disappointment. Frustration. Anger. Grief. Guilt. Shame. Hopelessness. Exhaustion.

As one can imagine, the stress of infertility can take quite a toll on patients. In fact, recent research has shown that the stress that infertility patients experience is equivalent to the stress of patients with other serious medical conditions such as cancer, HIV, or AIDS (Lombardo B., Eyre C. 2011). Infertility can be an unimaginably difficult diagnosis for patients, but one must wonder, what about the toll it takes on their nurses? Yes, delivering the news of positive pregnancy tests can be quite a rewarding feeling. But what happens to the nurse who has to call the same patient, month after month, cycle after cycle, with a negative pregnancy test? What happens when a nurse has built a very close relationship with a patient who has been trying and failing cycles for so long? Or when a patient gets released to her OBGYN after a great ultrasound but calls weeks later to report pregnancy loss?

One would assume that the words in the beginning of this article pertain to patients' feelings during the immensely difficult process of infertility. However, these words, in fact, are words that nurses have used to describe their own emotions when calling patients with negative pregnancy tests or pregnancy loss. Nurses working in the field of infertility wear many hats. We must be knowledgeable of the complex science of reproductive medicine but must also have the unique ability to provide compassionate and empathetic care, every single day, to every single patient. In 1992, Carla Johnson defined the term compassion fatigue as a form of burnout that healthcare givers experience after caring for patients with significant emotional or physical distress (Lombardo B., Eyre C. 2011). Compassion fatigue is experienced by nurses who begin to personally feel the pain and stress of their patients after consistently providing compassionate care. This stress occurs commonly in oncology, cardiac, or palliative care nursing, where patients require constant physical, emotional, and spiritual support.

Although it may not seem obvious at first, the field of infertility also falls under this category. In their case study, Lombardo and Eyre (2011) compare the reactive and proactive nurse dealing with compassion fatigue. Nurse #1 is a cardiac nurse working on a busy telemetry unit. With an intense patient load, this nurse was unable to take breaks and quickly became overwhelmed and exhausted. Other nurses and nurse managers began to notice her behavioral changes but did not offer to help or provide support. Her anxiety and fatigue eventually took a toll on her, and she was no longer able to give the empathetic care that her patients required. She eventually had to leave her job. Nurse #2 is a nurse who is also experiencing severe compassion fatigue. Working in a complex environment with a difficult patient population, she began to express how sad she felt for her patients' situations. She felt their pain and suffering, had difficulty sleeping, and even thought about her patients on her days off. The difference between nurse#1 and nurse #2 was that nurse #2 began to seek nurse specialists who counseled her to talk through her emotions. They helped her find other areas in nursing which interested her. After speaking with her supervisor, she was able to get several opportunities to explore these areas and eventually transfer to a new unit. Nurse #2 was proactive about her compassion fatigue and was able to seek help from managers and supervisors. In the end, instead of leaving her job, she felt reenergized and more excited about coming to work.

Lombardo and Eyre (2011) highlight the significance of having support systems in place. Being a Reproductive Endocrinology and Infertility (REI) nurse myself, I am familiar with the feeling of going home and still worrying about my patients - especially the ones going through a difficult time. Of course, in some ways, this is not always a bad thing. A good nurse is a nurse who cares. However, a good nurse also knows that if she does not take care of herself, then she cannot take care of her patients. The key component to a solid support system is the element of team work. Being able to simply turn your head away from your computer for a few minutes and talk with fellow nurses during difficult times is crucial. Any nurse will agree that the act of debriefing can go a long way.

The IVF nurse must sit right next to her patients and join them on their emotional rollercoaster ride. As we walk side by side with our patients down the life-changing path of infertility treatment, we experience our own emotions and our own highs and lows. While patients may not inform family and friends about what they are going through, they confide in their nurses. Having to deal with our own feelings, while providing a shoulder to cry on, takes a tremendous amount of stamina and endurance. The popular saying, "always put the patient first" is a well-known proverb in the field of infertility, but if we do not take the time to gain insight about our own emotions, we will not be able to provide optimal care.

I, myself, have grown very close to several patients who have certainly experienced both positive and negative cycle outcomes. I speak to them almost every day on the phone counseling them and providing support. I help them understand their lab results and educate them about their injections, I perform their inseminations, and in the end, I am the one who has to call them with their pregnancy test results. For the patients whose outcome is not what they had hoped for, I listen in silence as they cry on the phone while I gently try to reassure them and give hope. When I hang up I also feel their pain and sadness. For the patients I call with positive results, they cry in joy and tell me that it is the best news they have received all year. It is tremendously difficult to go through an 8 hour day and experience these highs and lows as I make my phone calls one by one. However, as difficult as it may be, I know that I have given each patient all the compassion and care that I am capable of giving. What many may not realize is that as this unique nurse-patient relationship grows, it becomes one of friendship and companionship, built around careful listening, hand holding, and most importantly, trust. We shake hands as we introduce ourselves during our very first meeting. But by the end we are hugging, as they walk out of our doors and out of our care, after seeing their new baby's heartbeat for the very first time.

Alina Ashjian is a registered nurse at Boston IVF. In her spare time, Alina is a dance instructor at the ABAKA School for the Performing Arts in Watertown, MA and spends time volunteering for non-profit Armenian organizations in Massachusetts.

Lombardo, B., Eyre, C., (Jan 31, 2011) "Compassion Fatigue: A Nurse's Primer" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1, Manuscript 3.

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